Basic Information
Provider Information
NPI: 1003298167
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SHAPIRO
FirstName: MELISSA
MiddleName: LAUREN
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 160 E ERIE AVE
Address2:  
City: PHILADELPHIA
State: PA
PostalCode: 191341011
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 160 E ERIE AVE
Address2:  
City: PHILADELPHIA
State: PA
PostalCode: 191341011
CountryCode: US
TelephoneNumber: 2154275000
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/25/2015
LastUpdateDate: 06/25/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208000000XMT208979PAY Allopathic & Osteopathic PhysiciansPediatrics 

ID Information
IDTypeStateIssuerDescription
MT20897901PAMEDICAL LICENSEOTHER


Home