Provider Demographics
NPI:1174938526
Name:SHAW, GREGORY
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:SHAW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1626 BLUEBELL TRL
Mailing Address - Street 2:JAMESON HOSPITAL
Mailing Address - City:POLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44514-5215
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:600 GRANT ST FL 56
Practice Address - Street 2:JAMESON HOSPITAL
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15219-2730
Practice Address - Country:US
Practice Address - Phone:412-996-5019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-24
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7305207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology