Provider Demographics
NPI:1720027188
Name:SHOULDICE, GREGORY DAWSON (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:DAWSON
Last Name:SHOULDICE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 WILLIAMS ST
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-7463
Mailing Address - Country:US
Mailing Address - Phone:413-445-4564
Mailing Address - Fax:413-448-2727
Practice Address - Street 1:740 WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-7463
Practice Address - Country:US
Practice Address - Phone:413-445-4564
Practice Address - Fax:413-448-2727
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA53102207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6183298Medicaid
MAM16029OtherMEDICARE GRP PIN
MA6183298Medicaid
MASHJ03513Medicare PIN
MAA57057Medicare UPIN