Healthcare Provider Details

I. General information

NPI: 1194302000
Provider Name (Legal Business Name): IAN MONTGOMERY SHAW DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: N/A N/A DO

II. Dates (important events)

Enumeration Date: 03/26/2021
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 HOPE DR
HERSHEY PA
17033-2008
US

IV. Provider business mailing address

500 UNIVERSITY DR MC CA410
HERSHEY PA
17033-2360
US

V. Phone/Fax

Practice location:
  • Phone: 717-531-1846
  • Fax: 717-531-0397
Mailing address:
  • Phone: 717-531-5208
  • Fax: 717-531-0119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License NumberOS026119
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC7-0018514
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: