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General NPI Number Information
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NPI Number | 1750426730
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Entity Type | Organization
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Legal Business Name | CHARLES H. SHAW, M.D., INC.
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Dates
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Enumeration Date | 02/20/2007
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Last Update Date | 02/28/2008
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Provider Practice Location Address
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Address Line | 370 CLINE AVE
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City | MANSFIELD
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State | OH
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Zip | 44907-1057
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Country | US
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Telephone | 419-756-8511
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Fax | 419-756-8513
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Provider Business Mailing Address
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Address Line | 370 CLINE AVE
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City | MANSFIELD
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State | OH
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Zip | 44907-1057
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Country | US
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Telephone | 419-756-8511
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Fax | 419-756-8513
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Authorized Official
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Title or Position | OWNER
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Name | CHARLES H. SHAW
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Credential | M.D.
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Telephone | 419-756-8511
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number |
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State | OH
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