Provider Demographics
NPI:1497763031
Name:SHINDLER, DERRICK WADE (MD)
Entity Type:Individual
Prefix:DR
First Name:DERRICK
Middle Name:WADE
Last Name:SHINDLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:8420 OCEAN GTWY
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-7150
Mailing Address - Country:US
Mailing Address - Phone:410-822-0424
Mailing Address - Fax:410-822-2283
Practice Address - Street 1:8420 OCEAN GTWY
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-7150
Practice Address - Country:US
Practice Address - Phone:410-822-0424
Practice Address - Fax:410-822-2283
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0063440207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDI39625Medicare UPIN
MD284MM224Medicare ID - Type Unspecified