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Individual
MARK H SHELLEY
Active
Individual
MARK H SHELLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD029656E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001403288001
—
PA
01
—
080023500
RAILROAD MEDICARE
PA
01
—
75710
HIGHMARK BLUE SHIELD
PA
Enumeration date
04/27/2006
Last updated
11/24/2010
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