MEDICARE: DR. ROBERT SHORE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	MD028196E	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	0045926000	OTHER	BS
2	497647	OTHER	AETNA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013020304
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT SHORE MD

Provider Business Mailing Address
First Line	:	7602 CENTRAL AVE
Second Line	:	STAPELEY BLDG SUITE 101
City	:	PHILA
State	:	PA
Zip	:	19111-2443
Country	:	US
Telephone Number	:	215-969-2900
Fax Number	:	215-969-1856

Provider Business Practice Location Address
First Line	:	7602 CENTRAL AVE
Second Line	:	STAPELEY BLDG SUITE 101
City	:	PHILA
State	:	PA
Zip	:	19111-2443
Country	:	US
Telephone Number	:	215-969-2900
Fax Number	:	215-969-1856

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2006
Last Update Date	:	10/10/2012

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Directions to “ DR. ROBERT SHORE MD” Practice Location

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