Individual
TIMOTHY R SHOPE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
750 EAST ADAMS ST, SYRACUSE, NY 13210
(315) 464-1800
(315) 464-6238
Mailing address
750 EAST ADAMS ST, SYRACUSE, NY 13210
(315) 464-1800
(315) 464-6238
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
313283
NY
208600000X
Surgery Physician
MD419316
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
06825254
—
NY
Enumeration date
04/26/2006
Last updated
03/22/2023
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