Provider Demographics
NPI:1548295991
Name:ELIZABETH J MCSHANE M D INC
Entity type:Organization
Organization Name:ELIZABETH J MCSHANE M D INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCSHANE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-698-2200
Mailing Address - Street 1:12291 WASHINGTON BLVD STE 301
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90606-3815
Mailing Address - Country:US
Mailing Address - Phone:562-698-2200
Mailing Address - Fax:562-698-5282
Practice Address - Street 1:12291 WASHINGTON BLVD STE 301
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90606-3815
Practice Address - Country:US
Practice Address - Phone:562-698-2200
Practice Address - Fax:562-698-5282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG73098207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG73098Medicare PIN
CA5513200001Medicare NSC
F36201Medicare UPIN