Individual
BRIAN R. SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
201 DATES DR STE 101, ITHACA, NY 14850-1345
(215) 840-6142
Mailing address
201 DATES DR STE 101, ITHACA, NY 14850-1345
(607) 272-0460
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
OS015512
PA
207R00000X
Internal Medicine Physician
OT012650
PA
207RC0000X
Cardiovascular Disease Physician
25MB08946200
NJ
207RC0000X
Cardiovascular Disease Physician
310717-01
NY
207RI0011X
Interventional Cardiology Physician
Primary
310717-01
NY
Other
Enumeration date
11/11/2009
Last updated
03/19/2024
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