Provider Demographics
NPI:1396755633
Name:SHILALA, PATRICK F (DO)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:F
Last Name:SHILALA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 HOSPITAL AVE
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-1440
Mailing Address - Country:US
Mailing Address - Phone:814-375-3471
Mailing Address - Fax:814-375-3472
Practice Address - Street 1:100 HOSPITAL AVE
Practice Address - Street 2:
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-1440
Practice Address - Country:US
Practice Address - Phone:814-375-3471
Practice Address - Fax:814-375-3472
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS-004686-L207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000151180OtherHIGHMARK BLUE CROSS
PA0009633500001Medicaid
PA151180Medicare ID - Type Unspecified
PA0009633500001Medicaid