Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0201X | Pediatric Allergist | MD025134E | PA |
NPI | 1558363085 |
---|---|
Provider Name | Mark P Shampain |
First Address | Allentown, PA 18104-4812 |
Second Address | Allentown, PA 18104-4812 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
08418110001 | (05) | PA |
B41430 | (02) |