Provider Demographics
NPI:1952411795
Name:DESHIELDS, MARY SPENCER (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:SPENCER
Last Name:DESHIELDS
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:509 IDLEWILD AVE
Mailing Address - Street 2:STE 1
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-3890
Mailing Address - Country:US
Mailing Address - Phone:410-819-3332
Mailing Address - Fax:410-819-3322
Practice Address - Street 1:401 PURDY STREET
Practice Address - Street 2:SUITE 101
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601
Practice Address - Country:US
Practice Address - Phone:410-819-3332
Practice Address - Fax:410-819-3322
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2024-03-26
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Provider Licenses
StateLicense IDTaxonomies
MDD47232207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD370351700Medicaid
MD691MMedicare ID - Type Unspecified
MD370351700Medicaid