Basic Information
| Provider Information | |||||||||
| NPI: | 1881156545 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | XU | ||||||||
| FirstName: | SHAOHUA | ||||||||
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| Credential: | MD, PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 549 FAIR ST # MC61-22 | ||||||||
| Address2: | |||||||||
| City: | BLOOMSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 178151419 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5704161913 | ||||||||
| FaxNumber: | 5703876185 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 N ACADEMY AVE | ||||||||
| Address2: | |||||||||
| City: | DANVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 178229800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5702716110 | ||||||||
| FaxNumber: | 5703876185 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2019 | ||||||||
| LastUpdateDate: | 11/19/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | TRAINING | PA | N | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 390200000X | MT217974 | PA | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.