Provider Demographics
NPI:1013975895
Name:SHIELDS, GREGORY S (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:S
Last Name:SHIELDS
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:PO BOX 1368
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14231-1368
Mailing Address - Country:US
Mailing Address - Phone:716-859-2954
Mailing Address - Fax:716-859-2962
Practice Address - Street 1:100 HIGH ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203-1126
Practice Address - Country:US
Practice Address - Phone:716-859-2954
Practice Address - Fax:716-859-2962
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2348182085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
00027018401OtherUNIVERA
195358FFOtherPREFERRED CARE
P010234818OtherBLUE CHOICE
000528027007OtherBLUE SHIELD WNY
00027018407OtherUNIVERA
000528027001OtherBLUE SHIELD WNY
1612805OtherINDEPENDENT HEALTH
NY02625074Medicaid
P00196037OtherRR MEDICARE
000528027005OtherBLUE SHIELD WNY
P00209389OtherRR MEDICARE
00027018405OtherUNIVERA
NY2348183WOtherWORKERS COMPENSATION
P020234818OtherBLUE SHIELD ROCHESTER
0142859OtherGHI
050901000062OtherFIDELIS
4193669OtherGHI
P040234818OtherBLUE SHIELD ROCHESTER
050901000062OtherFIDELIS
1612805OtherINDEPENDENT HEALTH
NY2348183WOtherWORKERS COMPENSATION
NYRA5932Medicare PIN
P040234818OtherBLUE SHIELD ROCHESTER