MEDICARE: DR. ANGELA M SHUPERT MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	35-083038	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00172340	OTHER	OH	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821043449
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANGELA M SHUPERT MD

Provider Business Mailing Address
First Line	:	1735 27TH ST STE B06
Second Line	:
City	:	PORTSMOUTH
State	:	OH
Zip	:	45662-2681
Country	:	US
Telephone Number	:	740-356-8681
Fax Number	:	740-353-7900

Provider Business Practice Location Address
First Line	:	90 CIC BLVD
Second Line	:
City	:	WEST UNION
State	:	OH
Zip	:	45693-8024
Country	:	US
Telephone Number	:	937-544-8989
Fax Number	:	937-544-5659

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	12/30/2020

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