Provider Demographics
NPI:1174524524
Name:SHIU, DENISE R (MD)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:R
Last Name:SHIU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DENISE
Other - Middle Name:R
Other - Last Name:EBERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1350 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WALPOLE
Mailing Address - State:MA
Mailing Address - Zip Code:02081-1718
Mailing Address - Country:US
Mailing Address - Phone:508-668-2200
Mailing Address - Fax:508-668-6539
Practice Address - Street 1:1350 MAIN ST
Practice Address - Street 2:
Practice Address - City:WALPOLE
Practice Address - State:MA
Practice Address - Zip Code:02081-1718
Practice Address - Country:US
Practice Address - Phone:508-668-2200
Practice Address - Fax:508-668-6539
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA156761208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
5425228OtherCIGNA
201802OtherHPHC
MA3182649Medicaid
P2772810OtherOXFORD
156761OtherMEDICAL LICENSE #
MA3182649OtherMEDICAID
32586OtherCMSP/HSP
5897661OtherAETNA/US HEALTHCARE
792143OtherTUFTS
2051898OtherAETNA/US HEALTHCARE HMO
MAJ19032OtherBCBS
32586OtherCMSP/HSP