Provider Demographics
NPI:1942203666
Name:SHILLING, GREGORY ALLEN (DPM)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:ALLEN
Last Name:SHILLING
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1880 RESERVOIR ST
Mailing Address - Street 2:STE A
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-8742
Mailing Address - Country:US
Mailing Address - Phone:540-434-3668
Mailing Address - Fax:540-574-0256
Practice Address - Street 1:1880 RESERVOIR ST
Practice Address - Street 2:STE A
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-8742
Practice Address - Country:US
Practice Address - Phone:540-434-3668
Practice Address - Fax:540-574-0256
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103000733213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1942203666Medicaid
VA1942203666Medicaid
VA1417288937Medicare NSC
VA1942203666Medicare PIN