Provider Demographics
NPI:1215028972
Name:SHIELD, DENNIS EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:EDWARD
Last Name:SHIELD
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 1:12 ELMCREST TER
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06850-3937
Mailing Address - Country:US
Mailing Address - Phone:203-853-4200
Mailing Address - Fax:203-854-9285
Practice Address - Street 1:12 ELMCREST TER
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06850-3937
Practice Address - Country:US
Practice Address - Phone:203-853-4200
Practice Address - Fax:203-854-9285
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT15022174400000X
CT015022208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT010015022CT01OtherANTHEM BC BS
CT020665OtherHEALTHNET
CT001150226Medicaid
CT340003225OtherRAILROAD MEDICARE
CT4270070OtherAETNA HEALTH CARE
CT150220OtherCONNECTICARE HEALTH PLAN
CTZS919OtherOXFORD HEALTH PLAN
CT340000161Medicare ID - Type Unspecified
CT340003225OtherRAILROAD MEDICARE