Provider Demographics
NPI:1891792651
Name:SHOCKLEY, MICHAEL C (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:C
Last Name:SHOCKLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:705 GARFIELD AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-5444
Mailing Address - Country:US
Mailing Address - Phone:304-485-4700
Mailing Address - Fax:304-485-4466
Practice Address - Street 1:705 GARFIELD AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-5444
Practice Address - Country:US
Practice Address - Phone:304-485-4700
Practice Address - Fax:304-485-4466
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV17290207VG0400X, 207V00000X
OH35065899207VG0400X, 207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0739623Medicare PIN
OH4152471Medicare PIN