Provider Demographics
NPI:1528021441
Name:SHELHORSE, MARK EDWIN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:EDWIN
Last Name:SHELHORSE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:300 W MORGAN ST
Mailing Address - Street 2:SUITE 700
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27701-2162
Mailing Address - Country:US
Mailing Address - Phone:919-956-5541
Mailing Address - Fax:919-956-7152
Practice Address - Street 1:300 W MORGAN ST
Practice Address - Street 2:SUITE 700
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27701-2162
Practice Address - Country:US
Practice Address - Phone:919-956-5541
Practice Address - Fax:919-956-7152
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL000124942084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry