Provider Demographics
NPI:1942241112
Name:MOYER, SHAWN S (MD)
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:S
Last Name:MOYER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3141 CAPE HORN RD
Mailing Address - Street 2:
Mailing Address - City:RED LION
Mailing Address - State:PA
Mailing Address - Zip Code:17356-9071
Mailing Address - Country:US
Mailing Address - Phone:717-246-5180
Mailing Address - Fax:717-246-2005
Practice Address - Street 1:3141 CAPE HORN RD
Practice Address - Street 2:
Practice Address - City:RED LION
Practice Address - State:PA
Practice Address - Zip Code:17356-9071
Practice Address - Country:US
Practice Address - Phone:717-246-5180
Practice Address - Fax:717-246-2005
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD073665L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA20024086OtherAMERIHEALTH MERCY HANNAH
PA20027090OtherAMERIHEALTH MERCY HANOVER
PAP004436OtherGATEWAY HEALTH PLAN
PA112705OtherUNISON
053520OtherMEDICARE PROVIDER NUMBER
PA20024093OtherAMERIHEALTH MERCY GEORGE
PA001865317Medicaid
PA02254101OtherCAPITAL BLUE CROSS/KEYSTO
PAH53230OtherHEALTH AMERICA/HEALTH ASS
PA20008818OtherAMERIHEALTH MERCY LEWISBE
PA1306974OtherHIGHMARK BLUE SHIELD
053520OtherMEDICARE PROVIDER NUMBER
PAH53230Medicare UPIN