MEDICARE: ALBERT BRIAN 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	2085R0202X	Diagnostic Radiology Physician	35.093989	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225127954
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALBERT BRIAN SHAW MD

Provider Business Mailing Address
First Line	:	1626 BLUEBELL TRL
Second Line	:
City	:	POLAND
State	:	OH
Zip	:	44514-5215
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1626 BLUEBELL TRL
Second Line	:
City	:	POLAND
State	:	OH
Zip	:	44514-5215
Country	:	US
Telephone Number	:	330-000-0000
Fax Number	:

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

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	12/02/2025

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Directions to “ ALBERT BRIAN SHAW MD” Practice Location

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