MEDICARE: JANE SHAW 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	207Q00000X	Family Medicine Physician	0101048714	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	080141642	OTHER	VA	MEDICARE PIN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	142736	OTHER	VA	SOUTHERN HEALTH
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	700010936	OTHER	VA	CIGNA
5	45186	OTHER	VA	COMMUNITY HEALTH
6	45186	OTHER	VA	OPTIMA/SENTARA
7	234066	OTHER	VA	ANTHEM SVC/HEALTHKEEPERS
8	267131	OTHER	VA	MAMSI

General Provider Information

NPI Number	:	1093789232
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANE SHAW MD

Provider Business Mailing Address
First Line	:	416 ALBEMARLE SQ
Second Line	:
City	:	CHARLOTTESVILLE
State	:	VA
Zip	:	22901-7400
Country	:	US
Telephone Number	:	434-978-2126
Fax Number	:	434-973-4452

Provider Business Practice Location Address
First Line	:	416 ALBEMARLE SQ
Second Line	:
City	:	CHARLOTTESVILLE
State	:	VA
Zip	:	22901-7400
Country	:	US
Telephone Number	:	434-978-2126
Fax Number	:	434-973-4452

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

Provider Enumeration Date	:	02/15/2006
Last Update Date	:	04/19/2012

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Directions to “ JANE SHAW MD” Practice Location

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