Provider Demographics
NPI:1669716254
Name:SHEPHERD, MICHAEL LAWRENCE (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:LAWRENCE
Last Name:SHEPHERD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:415 EAST MARKET STREET
Mailing Address - Street 2:EXECUTIVE SUITES ROOM 25
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22902-5264
Mailing Address - Country:US
Mailing Address - Phone:434-220-8062
Mailing Address - Fax:
Practice Address - Street 1:415 EAST MARKET ST
Practice Address - Street 2:EXECUTIVE SUITES ROOM 25
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22902-5264
Practice Address - Country:US
Practice Address - Phone:434-220-8062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-20
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010546182084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry