Individual
CHARLES H SHAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
370 CLINE AVENUE, MANSFIELD, OH 44907
(419) 756-8511
(419) 756-8513
Mailing address
4457 POSSUM RUN ROAD, BELLVILLE, OH 44813
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
35-04-5931
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000025568
ANTHEM
OH
05
—
0563840
—
OH
Enumeration date
07/18/2006
Last updated
07/09/2007
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