MEDICARE: DR. DAVID SHAPIRO 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
1	207R00000X	Internal Medicine Physician	017177	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	567690	OTHER	CT	AETNA
2	041902	OTHER	CT	HEALTHNET
3	P413636	OTHER	CT	OXFORD
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	010017177CT01	OTHER	CT	BLUE CROSS
6	751459	OTHER	CT	CONNECTICARE

General Provider Information

NPI Number	:	1558338913
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID SHAPIRO M.D.

Provider Business Mailing Address
First Line	:	155 GREENWOOD AVE
Second Line	:
City	:	BETHEL
State	:	CT
Zip	:	06801-2527
Country	:	US
Telephone Number	:	203-744-1639
Fax Number	:	203-748-1202

Provider Business Practice Location Address
First Line	:	155 GREENWOOD AVE
Second Line	:
City	:	BETHEL
State	:	CT
Zip	:	06801-2527
Country	:	US
Telephone Number	:	203-744-1639
Fax Number	:	203-748-1202

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

Provider Enumeration Date	:	03/03/2006
Last Update Date	:	08/27/2007

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Directions to “ DR. DAVID SHAPIRO M.D.” Practice Location

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