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1265435226

NPI Code Detail

MEDICARE: DR. MARC DOUGLAS SHIELDS MD

MEDICARE: DR. MARC DOUGLAS SHIELDS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	0101236216	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	137003	OTHER	VA	BLUE CROSS BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	137008	OTHER	VA	BLUE CROSS BLUE SHIELD
6	137010	OTHER	VA	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1265435226
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARC DOUGLAS SHIELDS MD

Provider Business Mailing Address
First Line	:	17 N MEDICAL PARK DR
Second Line	:
City	:	FISHERSVILLE
State	:	VA
Zip	:	22939-2344
Country	:	US
Telephone Number	:	540-213-7720
Fax Number	:	540-213-7728

Provider Business Practice Location Address
First Line	:	1500 COMMERCE RD
Second Line	:
City	:	STAUNTON
State	:	VA
Zip	:	24401-9032
Country	:	US
Telephone Number	:	540-213-7720
Fax Number	:	540-213-9441

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	07/08/2020

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Directions to “ DR. MARC DOUGLAS SHIELDS MD” Practice Location

Language	Start Address	Practice Location

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