Provider Demographics
NPI:1629168059
Name:SHEVIN, WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:
Last Name:SHEVIN
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 1:50 APPLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:CT
Mailing Address - Zip Code:06281
Mailing Address - Country:US
Mailing Address - Phone:860-928-4040
Mailing Address - Fax:860-928-0733
Practice Address - Street 1:50 APPLEWOOD DR
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:CT
Practice Address - Zip Code:06281
Practice Address - Country:US
Practice Address - Phone:860-928-4040
Practice Address - Fax:860-928-0733
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-14
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT021770208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT5191OtherHEALTHNET
010057604OtherRAILROAD MEDICARE
782878OtherCONNECTICARE
CT010021770CT01OtherBLUE CROSS BLUE SHIELD
080000113Medicare ID - Type Unspecified
010057604OtherRAILROAD MEDICARE