Individual
COLETTE SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
111 S 11TH ST, STE 3390, PHILADELPHIA, PA 19107-4824
(215) 955-6226
(215) 923-1562
Mailing address
111 S 11TH ST, STE 3390, PHILADELPHIA, PA 19107-4824
(215) 955-6226
(215) 923-1562
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
MD442733
PA
2085R0204X
Vascular & Interventional Radiology Physician
Primary
MD442733
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0266841
—
NJ
05
—
102615625
—
PA
Enumeration date
06/03/2009
Last updated
11/15/2011
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