Provider Demographics
NPI:1952385973
Name:SHIN, DAVID J (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:SHIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 843232
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02284-3232
Mailing Address - Country:US
Mailing Address - Phone:910-895-7227
Mailing Address - Fax:910-895-7089
Practice Address - Street 1:106 PHYSICIANS PARK DRIVE
Practice Address - Street 2:
Practice Address - City:ROCKINGHAM
Practice Address - State:NC
Practice Address - Zip Code:28376-7998
Practice Address - Country:US
Practice Address - Phone:910-895-7227
Practice Address - Fax:910-895-7089
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NH11938207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
1650366OtherCIGNA
01Y004791NH01OtherANTHEM
NH30203606Medicaid
NHRE7209Medicare ID - Type Unspecified
1650366OtherCIGNA