Provider Demographics
NPI:1205828365
Name:SHIELDS, DAVID SETH (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:SETH
Last Name:SHIELDS
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 1:2950 COLLEGE DR
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-6933
Mailing Address - Country:US
Mailing Address - Phone:856-691-1129
Mailing Address - Fax:856-691-1229
Practice Address - Street 1:2950 COLLEGE DR
Practice Address - Street 2:SUITE 2A
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-6933
Practice Address - Country:US
Practice Address - Phone:856-691-1129
Practice Address - Fax:856-691-1229
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05550700207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6118003Medicaid
NJF17395Medicare UPIN
NJ711202Medicare ID - Type Unspecified