Provider Demographics
NPI:1043366578
Name:NADIV SHAPIRA, MD PA
Entity type:Organization
Organization Name:NADIV SHAPIRA, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NADIV
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAPIRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-652-2291
Mailing Address - Street 1:1701 AUGUSTINE CUT OFF
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803-4415
Mailing Address - Country:US
Mailing Address - Phone:302-652-2291
Mailing Address - Fax:
Practice Address - Street 1:1701 AUGUSTINE CUT OFF
Practice Address - Street 2:SUITE 201
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-4415
Practice Address - Country:US
Practice Address - Phone:302-652-2291
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10003224208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000098301Medicaid
DE0000098301Medicaid
MD651MMedicare ID - Type Unspecified
D20001Medicare UPIN