Provider Demographics
NPI:1528001088
Name:SHEPHERD, AILSA CATRIONA (MD)
Entity Type:Individual
Prefix:
First Name:AILSA
Middle Name:CATRIONA
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2211 CONGRESS ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04122-0002
Mailing Address - Country:US
Mailing Address - Phone:207-575-2682
Mailing Address - Fax:
Practice Address - Street 1:2211 CONGRESS ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04122-0002
Practice Address - Country:US
Practice Address - Phone:207-575-2682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD16492207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME407040099Medicaid
MEME070702Medicare PIN
ME407040099Medicaid