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NPI Code Detail

MEDICARE: MARK P SHAMPAIN MD

MEDICARE: MARK P SHAMPAIN 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
12080P0201XPediatric Allergy/Immunology PhysicianMD025134EPA

Other Identifiers

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

General Provider Information

NPI Number : 1558363085
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK P SHAMPAIN MD
Provider Business Mailing Address
First Line : 3131 COLLEGE HEIGHTS BLVD
Second Line : STE 200
City : ALLENTOWN
State : PA
Zip : 18104-4812
Country : US
Telephone Number : 610-820-7611
Fax Number : 610-820-9884
Provider Business Practice Location Address
First Line : 3131 COLLEGE HEIGHTS BLVD
Second Line : STE 200
City : ALLENTOWN
State : PA
Zip : 18104-4812
Country : US
Telephone Number : 610-820-7611
Fax Number : 610-820-9884
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/15/2005
Last Update Date : 07/08/2007

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