Provider Demographics
NPI:1881156545
Name:XU, SHAOHUA (MD, PHD)
Entity type:Individual
Prefix:
First Name:SHAOHUA
Middle Name:
Last Name:XU
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 CENTRAL RD # 61-80
Mailing Address - Street 2:
Mailing Address - City:BLOOMSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17815-3121
Mailing Address - Country:US
Mailing Address - Phone:570-387-6150
Mailing Address - Fax:570-387-6185
Practice Address - Street 1:480 CENTRAL RD
Practice Address - Street 2:
Practice Address - City:BLOOMSBURG
Practice Address - State:PA
Practice Address - Zip Code:17815-3121
Practice Address - Country:US
Practice Address - Phone:570-387-5615
Practice Address - Fax:570-387-6185
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-02
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD481133204R00000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
No204R00000XAllopathic & Osteopathic PhysiciansElectrodiagnostic MedicineGroup - Single Specialty