Basic Information
| Provider Information | |||||||||
| NPI: | 1730149535 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TERRY | ||||||||
| FirstName: | SHAWN | ||||||||
| MiddleName: | MICHAEL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3241 CONCORD RD | ||||||||
| Address2: | |||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 174029001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7178511405 | ||||||||
| FaxNumber: | 7178511999 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 PINE GROVE CMNS | ||||||||
| Address2: | |||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 174035176 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7178516110 | ||||||||
| FaxNumber: | 7177411076 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/24/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | MD 072429-L | PA | N | Allopathic & Osteopathic Physicians | Surgery | 2086S0127X | MD 072429-L | PA | N | Allopathic & Osteopathic Physicians | Surgery | Trauma Surgery | 2086S0102X | MD 072429-L | PA | Y | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care |
ID Information
| ID | Type | State | Issuer | Description | 042318100 | 05 | MD | MEDICAID | 76582 | 01 | PA | GEISINGER | OTHER | 03274001 | 01 | PA | CAPITAL BLUE CROSS-WMG | OTHER | 1382426 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 416887 | 01 | PA | UPMC | OTHER | 001892305 | 05 | PA | MEDICAID | 104592 | 01 | PA | JOHNS HOPKINS | OTHER | 20013274 | 01 | PA | AMERIHEALTH MERCY-WMG | OTHER | 129774 | 01 | PA | UNISON-WMG | OTHER | 1523786 | 01 | PA | GATEWAY-WMG | OTHER | 7639048 | 01 | PA | AETNA | OTHER |