Basic Information
| Provider Information | |||||||||
| NPI: | 1275593881 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GLEESON | ||||||||
| FirstName: | SHELAGH | ||||||||
| MiddleName: | KATHLEEN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 850 KEMPSVILLE RD | ||||||||
| Address2: | |||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 235023920 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7572615910 | ||||||||
| FaxNumber: | 7572610171 | ||||||||
| Practice Location | |||||||||
| Address1: | 850 KEMPSVILLE RD | ||||||||
| Address2: | |||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 235023920 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7572615910 | ||||||||
| FaxNumber: | 7572610171 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2006 | ||||||||
| LastUpdateDate: | 04/28/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RP1001X | 0101244947 | VA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 207RC0200X | 0101244947 | VA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207R00000X | 0101244947 | VA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RS0012X | 0101244947 | VA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Sleep Medicine |
ID Information
| ID | Type | State | Issuer | Description | P00205649 | 01 | MEDICARE RAILROAD | OTHER | 042161CT01 | 01 | CT | ANTHEM BLUE CROSS | OTHER |