Provider Demographics
NPI:1831491703
Name:SHELDON E. GINGERICH, MD, PC
Entity Type:Organization
Organization Name:SHELDON E. GINGERICH, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:STARKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-545-1765
Mailing Address - Street 1:2902 E GRANT RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716-2742
Mailing Address - Country:US
Mailing Address - Phone:520-322-8440
Mailing Address - Fax:520-322-8462
Practice Address - Street 1:2902 E GRANT RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-2742
Practice Address - Country:US
Practice Address - Phone:520-322-8440
Practice Address - Fax:520-322-8462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-29
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ14436208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ25566303Medicaid
AZ25566303Medicaid
AZD36911Medicare UPIN