Provider Demographics
NPI:1003896192
Name:GINGERICH, SHELDON E (MD)
Entity Type:Individual
Prefix:
First Name:SHELDON
Middle Name:E
Last Name:GINGERICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 N ALVERNON WAY
Mailing Address - Street 2:#280
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711
Mailing Address - Country:US
Mailing Address - Phone:520-322-8440
Mailing Address - Fax:520-322-8462
Practice Address - Street 1:630 N ALVERNON WAY
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711
Practice Address - Country:US
Practice Address - Phone:520-322-8440
Practice Address - Fax:520-322-8462
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ14436208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ25566303Medicaid
AZ24361Medicare ID - Type Unspecified
D36911Medicare UPIN