MEDICARE: DR. WILLIAM A SHADE

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	35060439	OH

Other Identifiers

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

General Provider Information

NPI Number	:	1104816321
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM A SHADE

Provider Business Mailing Address
First Line	:	PO BOX 1821
Second Line	:
City	:	ZANESVILLE
State	:	OH
Zip	:	43702-1821
Country	:	US
Telephone Number	:	740-455-3342
Fax Number	:	740-455-3686

Provider Business Practice Location Address
First Line	:	945 BETHESDA DR
Second Line	:
City	:	ZANESVILLE
State	:	OH
Zip	:	43701-0801
Country	:	US
Telephone Number	:	740-455-4530
Fax Number	:	740-454-4647

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

Provider Enumeration Date	:	10/27/2005
Last Update Date	:	02/19/2010

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Directions to “ DR. WILLIAM A SHADE ” Practice Location

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