Provider Demographics
NPI:1407946510
Name:DOPSON, SHIRLEY JAYAKUMAR (DO)
Entity Type:Individual
Prefix:DR
First Name:SHIRLEY
Middle Name:JAYAKUMAR
Last Name:DOPSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:764 LOCUST AVE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-2756
Mailing Address - Country:US
Mailing Address - Phone:724-228-1303
Mailing Address - Fax:
Practice Address - Street 1:764 LOCUST AVE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-2756
Practice Address - Country:US
Practice Address - Phone:724-228-1303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS012769207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA124626CGKMedicare PIN