=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528411253
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SCOTT D. SHAPIRO M.D., PH.D., LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/18/2016
-----------------------------------------------------
Last Update Date | 02/26/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5530 WISCONSIN AVE STE 1248
-----------------------------------------------------
City | CHEVY CHASE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20815-4301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-654-1059
-----------------------------------------------------
Fax | 301-654-3761
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5530 WISCONSIN AVE STE 1248
-----------------------------------------------------
City | CHEVY CHASE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20815-4301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-654-1059
-----------------------------------------------------
Fax | 301-654-3761
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. SCOTT D SHAPIRO
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 301-654-1059
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0001X
-----------------------------------------------------
Taxonomy Name | Clinical Cardiac Electrophysiology Physician
-----------------------------------------------------
License Number | D0070911
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | D0070911
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------