Provider Demographics
NPI:1235271040
Name:MOTEN, SHIRLENE TOLBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:SHIRLENE
Middle Name:TOLBERT
Last Name:MOTEN
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 1:4314 N. GEORGE ST EXT'D
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:17345-1307
Mailing Address - Country:US
Mailing Address - Phone:717-266-0252
Mailing Address - Fax:717-266-2199
Practice Address - Street 1:4314 N. GEORGE ST EXT'D
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:PA
Practice Address - Zip Code:17345-1307
Practice Address - Country:US
Practice Address - Phone:717-266-0252
Practice Address - Fax:717-266-2199
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101054986207Q00000X
NJ25MA05551200207Q00000X
PAMD048444L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAF78265Medicare UPIN