Provider Demographics
NPI:1235975673
Name:STUDHOLME, SHAWN JUSTIN (RTR)
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:JUSTIN
Last Name:STUDHOLME
Suffix:
Gender:M
Credentials:RTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 GOAH WAY
Mailing Address - Street 2:
Mailing Address - City:CHINA
Mailing Address - State:ME
Mailing Address - Zip Code:04358-5460
Mailing Address - Country:US
Mailing Address - Phone:207-877-4976
Mailing Address - Fax:
Practice Address - Street 1:1 VA CTR
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-6796
Practice Address - Country:US
Practice Address - Phone:877-421-8263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-04
Last Update Date:2024-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERT400052892085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology