Provider Demographics
NPI:1265435226
Name:SHIELDS, MARC DOUGLAS (MD)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:DOUGLAS
Last Name:SHIELDS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:17 N MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:FISHERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22939-2344
Mailing Address - Country:US
Mailing Address - Phone:540-213-7720
Mailing Address - Fax:540-213-7728
Practice Address - Street 1:1500 COMMERCE RD
Practice Address - Street 2:
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401-9032
Practice Address - Country:US
Practice Address - Phone:540-213-7720
Practice Address - Fax:540-213-9441
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2020-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101236216207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010058252Medicaid
VA137003OtherBLUE CROSS BLUE SHIELD
VA010058228Medicaid
VA010058244Medicaid
VA137008OtherBLUE CROSS BLUE SHIELD
VA137010OtherBLUE CROSS BLUE SHIELD
H78148Medicare UPIN
VA137008OtherBLUE CROSS BLUE SHIELD