Healthcare Provider Details

I. General information

NPI: 1174524524
Provider Name (Legal Business Name): DENISE R SHIU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: DENISE R EBERSON MD

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 MAIN ST
WALPOLE MA
02081-1718
US

IV. Provider business mailing address

1350 MAIN ST
WALPOLE MA
02081-1718
US

V. Phone/Fax

Practice location:
  • Phone: 508-668-2200
  • Fax: 508-668-6539
Mailing address:
  • Phone: 508-668-2200
  • Fax: 508-668-6539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number156761
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier5425228
Identifier TypeOTHER
Identifier State
Identifier IssuerCIGNA
# 2
Identifier201802
Identifier TypeOTHER
Identifier State
Identifier IssuerHPHC
# 3
Identifier3182649
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer
# 4
IdentifierP2772810
Identifier TypeOTHER
Identifier State
Identifier IssuerOXFORD
# 5
Identifier156761
Identifier TypeOTHER
Identifier State
Identifier IssuerMEDICAL LICENSE #
# 6
Identifier3182649
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerMEDICAID
# 7
Identifier32586
Identifier TypeOTHER
Identifier State
Identifier IssuerCMSP/HSP
# 8
Identifier5897661
Identifier TypeOTHER
Identifier State
Identifier IssuerAETNA/US HEALTHCARE
# 9
Identifier792143
Identifier TypeOTHER
Identifier State
Identifier IssuerTUFTS
# 10
Identifier2051898
Identifier TypeOTHER
Identifier State
Identifier IssuerAETNA/US HEALTHCARE HMO
# 11
IdentifierJ19032
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerBCBS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: