Provider Demographics
NPI:1912962275
Name:SHAPIRO, MARK H (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:H
Last Name:SHAPIRO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4225 EXECUTIVE SQ STE 450
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-8411
Mailing Address - Country:US
Mailing Address - Phone:858-810-0000
Mailing Address - Fax:858-268-1911
Practice Address - Street 1:631 E GRAND AVE
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-4402
Practice Address - Country:US
Practice Address - Phone:760-294-1660
Practice Address - Fax:760-745-5016
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2021-02-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG65280207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGP075ZOtherPTAN
CAWG65280EMedicare ID - Type Unspecified