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NPI Code Detail

MEDICARE: DR. WAN SHIN M.D.

MEDICARE: DR. WAN SHIN M.D.
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
1208100000XPhysical Medicine & Rehabilitation Physician0101030663VA
22081P0004XSpinal Cord Injury Medicine Physician0101030663VA
32081P2900XPain Medicine (Physical Medicine & Rehabilitation) Physician0101030663VA
42081S0010XSports Medicine (Physical Medicine & Rehabilitation) Physician0101030663VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1073521340
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. WAN SHIN M.D.
Provider Business Mailing Address
First Line : PO BOX 1460
Second Line :
City : FREDERICKSBURG
State : VA
Zip : 22402-1460
Country : US
Telephone Number : 540-786-2100
Fax Number : 540-786-0677
Provider Business Practice Location Address
First Line : 300 PARK HILL DR
Second Line :
City : FREDERICKSBURG
State : VA
Zip : 22401-3387
Country : US
Telephone Number : 540-361-7641
Fax Number : 540-361-1246
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/03/2006
Last Update Date : 03/21/2012

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