Provider Demographics
NPI:1346330990
Name:SHEPARD, RICHARD K (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:K
Last Name:SHEPARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RICHARD
Other - Middle Name:KESNIEL
Other - Last Name:SHEPARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 980053
Mailing Address - Street 2:GATEWAY BLDG 3RD FLOOR
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23298-0053
Mailing Address - Country:US
Mailing Address - Phone:804-828-7565
Mailing Address - Fax:804-828-6082
Practice Address - Street 1:1200 E MARSHALL ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298-5049
Practice Address - Country:US
Practice Address - Phone:804-828-7565
Practice Address - Fax:804-828-6082
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101051562207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6041141Medicaid
110005694Medicare ID - Type Unspecified
VA6041141Medicaid