Healthcare Provider Details

I. General information

NPI: 1730599606
Provider Name (Legal Business Name): EVAN SHEPPARD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2014
Last Update Date: 02/17/2022
Certification Date: 02/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MICHIGAN AVE NW FLOOR 3.5 WEST WING SUITE 600
WASHINGTON DC
20010-2916
US

IV. Provider business mailing address

3300 GALLOWS RD
FALLS CHURCH VA
22042-3300
US

V. Phone/Fax

Practice location:
  • Phone: 202-476-5992
  • Fax:
Mailing address:
  • Phone: 703-776-4001
  • Fax: 703-776-7113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License NumberMD047149
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number0101270407
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: