Healthcare Provider Details

I. General information

NPI: 1538515952
Provider Name (Legal Business Name): SHORE ORTHOPEDICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2016
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 IDLEWILD AVE
EASTON MD
21601-3881
US

IV. Provider business mailing address

510 IDLEWILD AVE
EASTON MD
21601-3881
US

V. Phone/Fax

Practice location:
  • Phone: 410-820-8226
  • Fax: 410-820-8405
Mailing address:
  • Phone: 410-820-8226
  • Fax: 410-820-8405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: JASON JANCOSKO
Title or Position: AUTHORIZED OFFICIAL
Credential: DO
Phone: 410-820-8226