Provider Demographics
NPI:1487668075
Name:MIDDLETON, SHIRLEY PAULINE (MD)
Entity Type:Individual
Prefix:DR
First Name:SHIRLEY
Middle Name:PAULINE
Last Name:MIDDLETON
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 1:4301 CONNECTICUT AVE NW STE 125
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20008-2332
Mailing Address - Country:US
Mailing Address - Phone:202-362-4545
Mailing Address - Fax:301-896-0968
Practice Address - Street 1:4301 CONNECTICUT AVE NW STE 125
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008
Practice Address - Country:US
Practice Address - Phone:202-362-4545
Practice Address - Fax:301-896-0968
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD916264207W00000X
DCMD25821207W00000X
VA0101840541207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC021992600Medicaid
B67028Medicare UPIN