1013975895 NPI number — DR. GREGORY S SHIELDS MD

Table of content: DR. GREGORY S SHIELDS MD (NPI 1013975895)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013975895 NPI number — DR. GREGORY S SHIELDS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHIELDS
Provider First Name:
GREGORY
Provider Middle Name:
S
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013975895
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/06/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1368
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILLIAMSVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14231-1368
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-859-2954
Provider Business Mailing Address Fax Number:
716-859-2962

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 HIGH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BUFFALO
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14203-1126
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-859-2954
Provider Business Practice Location Address Fax Number:
716-859-2962
Provider Enumeration Date:
05/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  234818 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00027018401 . This is a "UNIVERA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 195358FF . This is a "PREFERRED CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: P010234818 . This is a "BLUE CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000528027007 . This is a "BLUE SHIELD WNY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00027018407 . This is a "UNIVERA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000528027001 . This is a "BLUE SHIELD WNY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1612805 . This is a "INDEPENDENT HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 02625074 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00196037 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000528027005 . This is a "BLUE SHIELD WNY" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00209389 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00027018405 . This is a "UNIVERA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2348183W . This is a "WORKERS COMPENSATION" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P020234818 . This is a "BLUE SHIELD ROCHESTER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0142859 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 050901000062 . This is a "FIDELIS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4193669 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
  • Identifier: P040234818 . This is a "BLUE SHIELD ROCHESTER" identifier . This identifiers is of the category "OTHER".




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