Provider Demographics
NPI:1174536981
Name:GASOW, SHELLY L (MD)
Entity type:Individual
Prefix:
First Name:SHELLY
Middle Name:L
Last Name:GASOW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 E ST NW
Mailing Address - Street 2:L209
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20037
Mailing Address - Country:US
Mailing Address - Phone:202-235-7475
Mailing Address - Fax:202-261-8651
Practice Address - Street 1:2401 E ST NW L209
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037
Practice Address - Country:US
Practice Address - Phone:202-235-7475
Practice Address - Fax:202-261-8651
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2025-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0039662207Q00000X
DC600003168207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1009063Medicaid
VTVN2964Medicare ID - Type UnspecifiedMEDICARE
VT1009063Medicaid