Provider Demographics
NPI:1770673824
Name:SHEPARD, MARC (MD)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:
Last Name:SHEPARD
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 1:4200 HAREWOOD RD NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017-1511
Mailing Address - Country:US
Mailing Address - Phone:202-269-1831
Mailing Address - Fax:202-832-6341
Practice Address - Street 1:4200 HAREWOOD RD NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-1511
Practice Address - Country:US
Practice Address - Phone:202-269-1831
Practice Address - Fax:202-832-6341
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC12080207R00000X
MDD0026382207R00000X
NY302575207R00000X
DCMD12080207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC415507S24OtherMEDICARE INDIV PTAN
DCC62682Medicare UPIN
153124Medicare PIN