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General NPI Number Information
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NPI Number | 1669716254
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Entity Type | Individual
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Provider Name | MICHAEL LAWRENCE SHEPHERD MD
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Gender | Male
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Dates
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Enumeration Date | 11/20/2012
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Last Update Date | 11/20/2012
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Provider Practice Location Address
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Address Line | 415 EAST MARKET ST EXECUTIVE SUITES ROOM 25
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22902-5264
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Country | US
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Telephone | 434-220-8062
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Fax |
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Provider Business Mailing Address
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Address Line | 415 EAST MARKET STREET EXECUTIVE SUITES ROOM 25
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22902-5264
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Country | US
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Telephone | 434-220-8062
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 0101054618
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License Number State | VA
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