Provider Demographics
NPI:1881600948
Name:SHAPIRO, CHARLES ANDREW (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:ANDREW
Last Name:SHAPIRO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202-28 45TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-2540
Mailing Address - Country:US
Mailing Address - Phone:718-224-7600
Mailing Address - Fax:
Practice Address - Street 1:202-28 45TH AVENUE
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-2540
Practice Address - Country:US
Practice Address - Phone:718-224-7600
Practice Address - Fax:718-224-0593
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0187008207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF77942Medicare UPIN
NY01336Medicare PIN
NY16J622Medicare PIN