Individual
SAMUEL MARK SHOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1860 TOWN CENTER DR, SUITE 230, RESTON, VA 20190-5896
(703) 709-1119
(703) 709-7496
Mailing address
1860 TOWN CENTER DR, SUITE 230, RESTON, VA 20190-5896
(703) 709-1119
(703) 709-7496
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
101036333
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
504468
NCPPO PROVIDER NUMBER
VA
01
—
745990
CIGNA PROVIDER NUMBER
VA
Enumeration date
10/05/2005
Last updated
01/05/2012
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