Provider Demographics
NPI:1528156460
Name:SHIRLEY, GAIL ELLEN (DO)
Entity type:Individual
Prefix:
First Name:GAIL
Middle Name:ELLEN
Last Name:SHIRLEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 E BROWN ST
Mailing Address - Street 2:POCONO HEALTHCARE MANAGEMENT-PROFESSIONAL CENTER
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-3006
Mailing Address - Country:US
Mailing Address - Phone:570-420-4951
Mailing Address - Fax:570-476-3754
Practice Address - Street 1:RTE 611 & FRANTZ RD. BARTONSVILLE PLAZA, 7
Practice Address - Street 2:PMC PHYSICIAN ASSOCIATES INTERNAL MEDICINE
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360
Practice Address - Country:US
Practice Address - Phone:570-476-3700
Practice Address - Fax:570-476-3637
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS005037L207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2822326OtherAETNA PROVIDER NUMBER
PAP661341OtherOXFORD PROVIDER NUMBER
PA5997984OtherGHI PROVIDER NUMBER
PAD75905Medicare UPIN
PA114667Medicare PIN