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General NPI Number Information
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NPI Number | 1265834196
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Entity Type | Organization
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Legal Business Name | SHAMBAUGH PEDIATRICS INC
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Dates
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Enumeration Date | 09/23/2014
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Last Update Date | 09/23/2014
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Provider Practice Location Address
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Address Line | 106 CENTRE DR
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City | NEW BLOOMFIELD
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State | PA
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Zip | 17068-9675
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Country | US
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Telephone | 717-582-2181
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Fax |
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Provider Business Mailing Address
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Address Line | 106 CENTRE DR
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City | NEW BLOOMFIELD
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State | PA
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Zip | 17068-9675
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Country | US
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Telephone | 717-582-2181
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. COREY D SHAMBAUGH
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Credential | MD
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Telephone | 717-582-2181
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MD437020
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License Number State | PA
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