Provider Demographics
NPI:1609846906
Name:GASKILL-SHIPLEY, MARY F (MD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:F
Last Name:GASKILL-SHIPLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 GOODMAN ST
Mailing Address - Street 2:RADIOLOGY
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2364
Mailing Address - Country:US
Mailing Address - Phone:513-584-1584
Mailing Address - Fax:513-584-9100
Practice Address - Street 1:234 GOODMAN ST
Practice Address - Street 2:RADIOLOGY
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2364
Practice Address - Country:US
Practice Address - Phone:513-584-1584
Practice Address - Fax:513-584-9100
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350519322085R0202X
OH35-05-19322085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH655246OtherAETNA
OH000000014168OtherANTHEM
IN100020480AMedicaid
KY64788680Medicaid
OH1620964OtherUNITED HEALTHCARE
OH0660646Medicaid
WV0208428000Medicaid
OH0660646Medicaid
OH655246OtherAETNA