Provider Demographics
NPI:1205881745
Name:SHAINBERG, JODI (MD)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:
Last Name:SHAINBERG
Suffix:
Gender:F
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:PO BOX 890291
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28289-0291
Mailing Address - Country:US
Mailing Address - Phone:828-277-4810
Mailing Address - Fax:828-277-4847
Practice Address - Street 1:90 SOUTHSIDE AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-4100
Practice Address - Country:US
Practice Address - Phone:828-277-4810
Practice Address - Fax:828-277-4847
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9501092207P00000X, 207RG0300X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8976010Medicaid
NC76010OtherBLUE CROSS
NC2222358HMedicare PIN
NC76010OtherBLUE CROSS
NC2222358EMedicare PIN
NC2222358GMedicare PIN