Healthcare Provider Details

I. General information

NPI: 1528156460
Provider Name (Legal Business Name): GAIL ELLEN SHIRLEY D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 11/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RTE 611 & FRANTZ RD. BARTONSVILLE PLAZA, 7 PMC PHYSICIAN ASSOCIATES INTERNAL MEDICINE
STROUDSBURG PA
18360
US

IV. Provider business mailing address

206 E BROWN ST POCONO HEALTHCARE MANAGEMENT-PROFESSIONAL CENTER
EAST STROUDSBURG PA
18301-3006
US

V. Phone/Fax

Practice location:
  • Phone: 570-476-3700
  • Fax: 570-476-3637
Mailing address:
  • Phone: 570-420-4951
  • Fax: 570-476-3754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberOS005037L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: