Healthcare Provider Details

I. General information

NPI: 1952385973
Provider Name (Legal Business Name): DAVID J SHIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2005
Last Update Date: 06/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 PHYSICIANS PARK DRIVE
ROCKINGHAM NC
28376-7998
US

IV. Provider business mailing address

PO BOX 843232
BOSTON MA
02284-3232
US

V. Phone/Fax

Practice location:
  • Phone: 910-895-7227
  • Fax: 910-895-7089
Mailing address:
  • Phone: 910-895-7227
  • Fax: 910-895-7089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number11938
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: