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General NPI Number Information
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NPI Number | 1043717424
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Entity Type | Individual
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Provider Name | JONATHAN DE SHIELDS MD
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Gender | Male
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Dates
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Enumeration Date | 04/11/2018
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Last Update Date | 12/19/2021
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Provider Practice Location Address
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Address Line | 10810 CONNECTICUT AVE
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City | KENSINGTON
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State | MD
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Zip | 20895-2138
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Country | US
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Telephone | 301-297-1003
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Fax |
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Provider Business Mailing Address
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Address Line | 7651 WOODLAND DR
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City | EASTON
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State | MD
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Zip | 21601-8141
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Country | US
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Telephone | 410-822-9685
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | D0092482
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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