Provider Demographics
NPI:1164405270
Name:SHAPIRO, MARK L (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:L
Last Name:SHAPIRO
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 1:2800 E BROAD ST STE 421
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-6415
Mailing Address - Country:US
Mailing Address - Phone:469-695-2028
Mailing Address - Fax:469-695-2029
Practice Address - Street 1:2800 E BROAD ST STE 421
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-6415
Practice Address - Country:US
Practice Address - Phone:469-695-2028
Practice Address - Fax:469-695-2029
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDMC-0787208600000X
MA219511208600000X
MEMD23567208600000X
NC2006-01252208600000X
WAMD616126692086S0102X
TXV40682086S0127X
MIEMC00006562086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2021536Medicaid
NC1431ROtherBCBS
H87219Medicare UPIN
MA2021536Medicaid
MASH A36100Medicare ID - Type Unspecified