MEDICARE: MARIANNE L SHAW 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	207RR0500X	Rheumatology Physician	MD4238723	PA

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	338517	OTHER	PA	BLUE SHIELD

General Provider Information

NPI Number	:	1790785582
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIANNE L SHAW M.D.

Provider Business Mailing Address
First Line	:	154 HOSPITAL DR
Second Line	:
City	:	TYRONE
State	:	PA
Zip	:	16686
Country	:	US
Telephone Number	:	814-684-6341
Fax Number	:	814-684-6343

Provider Business Practice Location Address
First Line	:	154 HOSPITAL DR
Second Line	:
City	:	TYRONE
State	:	PA
Zip	:	16686
Country	:	US
Telephone Number	:	814-684-6341
Fax Number	:	814-684-6343

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

Provider Enumeration Date	:	07/22/2005
Last Update Date	:	08/02/2024

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