Provider Demographics
NPI:1700804721
Name:SHEPARD, DOUGLAS MITCHELL (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:MITCHELL
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 1:341 N CALVERT ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-3633
Mailing Address - Country:US
Mailing Address - Phone:410-986-4400
Mailing Address - Fax:410-986-4411
Practice Address - Street 1:341 N CALVERT ST
Practice Address - Street 2:SUITE 300
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-3633
Practice Address - Country:US
Practice Address - Phone:410-986-4400
Practice Address - Fax:410-986-4411
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0040555207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD10415312OtherCAQH
MD521501OtherCAREFIRST
MDC21729Medicare UPIN
MDB749Medicare ID - Type Unspecified