Provider Demographics
NPI:1346336930
Name:FUNG, SHIRLEY M (MD)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:M
Last Name:FUNG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1015 CHESTNUT ST STE 1300
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4398
Mailing Address - Country:US
Mailing Address - Phone:215-923-7685
Mailing Address - Fax:
Practice Address - Street 1:1015 CHESTNUT ST STE 1300
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4398
Practice Address - Country:US
Practice Address - Phone:215-923-7685
Practice Address - Fax:215-923-8230
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY231928207R00000X
PA418839207R00000X, 207RA0201X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA113635Medicare PIN