Provider Demographics
NPI:1548290125
Name:SHIRLEY, ERIC (MD)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:SHIRLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:171 KEMPSVILLE RD BLDG A
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-4700
Mailing Address - Country:US
Mailing Address - Phone:757-668-6550
Mailing Address - Fax:757-668-6545
Practice Address - Street 1:NAVAL MEDICAL CENTER PORTSMOUTH
Practice Address - Street 2:620 JOHN PAUL JONES CIRCLE
Practice Address - City:PORTSMOUTH
Practice Address - State:VI
Practice Address - Zip Code:23708
Practice Address - Country:US
Practice Address - Phone:757-953-1428
Practice Address - Fax:757-953-0815
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2024-02-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD426437207X00000X
GA076954207X00000X
FLME109178207XP3100X
VA0101248597207XP3100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3132212OtherCIGNA- NORTON
KY200907490OtherMD WISE- CHILDREN'S ORTHOPAEDICS OF LOUISVILLE
KY7100028780OtherMEDICAID- CHILDREN'S ORTHOPAEDICS OF LOUISVILLE
IN200907490OtherMEDICAID- CHILDREN'S ORTHOPAEDICS OF LOUISVILLE
PAI50213Medicare UPIN
KY092966OtherSIHO- NORTON
KY50017892OtherPASSPORT- NORTON
KY0998885OtherMEDICARE- NORTON
KY000000542875OtherANTHEM- NORTON
PA1014956670001Medicaid
KY3430874000OtherPASSPORT ADVANTAGE- CHILDREN'S ORTHOPAEDICS OF LOUISVILLE