Provider Demographics
NPI:1144219296
Name:SHEPARD, ARTHUR J III (MD)
Entity Type:Individual
Prefix:
First Name:ARTHUR
Middle Name:J
Last Name:SHEPARD
Suffix:III
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 1:3501 TABSCOTT RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:VA
Mailing Address - Zip Code:23038-2607
Mailing Address - Country:US
Mailing Address - Phone:843-697-1711
Mailing Address - Fax:
Practice Address - Street 1:1602 SKIPWITH RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-5298
Practice Address - Country:US
Practice Address - Phone:804-289-4985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC397442080N0001X
GA399392080N0001X
SC20-223912080N0001X
VA01012583592080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCF25779Medicare UPIN