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General NPI Number Information
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NPI Number | 1932212214
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Entity Type | Individual
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Provider Name | IRA G. SHAYWITZ M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/17/2006
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Last Update Date | 07/21/2021
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Provider Practice Location Address
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Address Line | 1906 BELLEVIEW AVE SE
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City | ROANOKE
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State | VA
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Zip | 24014-1838
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Country | US
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Telephone | 540-981-7037
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Fax | 540-342-1757
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Provider Business Mailing Address
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Address Line | 545 ELMONT RD
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City | ELMONT
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State | NY
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Zip | 11003-4002
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Country | US
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Telephone | 516-354-4200
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Fax | 516-775-1972
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 238089
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 0101253529
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License Number State | VA
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