Roger B Shambo, MD, LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

165521 Issued in NY

Legal business name

ROGER B SHAMBO, MD, LLC

Practice address

9732 State Route 12
Copenhagen, NY 13626-0026

Phone

(315) 688-2305

Fax

(315) 688-2139

NPI assigned

Jun 25, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Roger B Shambo, MDNPI 1649251489

Title

Owner

Phone

(315) 688-2305

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Roger Brian Shambo, MD

  • Family Medicine Physician
  • Beaver Falls, NY
  • NPI 1649251489
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1182729600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1215133491",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9732 STATE ROUTE 12",
            "address_2": "PO BOX 26",
            "city": "COPENHAGEN",
            "state": "NY",
            "postal_code": "136260026",
            "telephone_number": "315-688-2305",
            "fax_number": "315-688-2139"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9732 STATE ROUTE 12",
            "city": "COPENHAGEN",
            "state": "NY",
            "postal_code": "136260026",
            "telephone_number": "315-688-2305",
            "fax_number": "315-688-2139"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROGER B SHAMBO, MD, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-25",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SHAMBO",
        "authorized_official_first_name": "ROGER",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "315-688-2305",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "165521",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary K Greene, MA, CCC/SLP
• Lewis County General Hospital
• Elizabeth A Marolf-Zehr, M.ED, SPED
• Jacob M Ratliff, LPN
• Laci Lynn Reilly, APRN
• Norman Bruce Scott, D.O.
• Michelle Anne Shoen
• Rachel L Slate, LPN
• Youth of Lewis County

• Family Medicine Physician in Copenhagen, NY
• Providers in Copenhagen, NY by specialty
• Family Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.