Provider Demographics
NPI:1134125602
Name:SHAVERS, JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:SHAVERS
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 1:518 S CAMP MEADE RD
Mailing Address - Street 2:
Mailing Address - City:LINTHICUM HTS
Mailing Address - State:MD
Mailing Address - Zip Code:21090-2766
Mailing Address - Country:US
Mailing Address - Phone:410-859-0355
Mailing Address - Fax:410-859-9183
Practice Address - Street 1:518 S CAMP MEADE RD
Practice Address - Street 2:
Practice Address - City:LINTHICUM HTS
Practice Address - State:MD
Practice Address - Zip Code:21090-2766
Practice Address - Country:US
Practice Address - Phone:410-859-0355
Practice Address - Fax:410-859-9183
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD27838207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine