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NPI Code Detail

MEDICARE: DR. CORNELL SHELTON MD

MEDICARE: DR. CORNELL SHELTON 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
1208100000XPhysical Medicine & Rehabilitation Physician0101251254VA
2208100000XPhysical Medicine & Rehabilitation Physician80380MA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1003807538
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CORNELL SHELTON MD
Provider Business Mailing Address
First Line : 6035 BURKE CENTRE PKWY STE 390
Second Line :
City : BURKE
State : VA
Zip : 22015-3750
Country : US
Telephone Number : 703-978-1196
Fax Number : 703-978-7762
Provider Business Practice Location Address
First Line : 300 PARK HILL DR
Second Line :
City : FREDERICKSBURG
State : VA
Zip : 22401-3387
Country : US
Telephone Number : 703-978-1196
Fax Number : 703-978-7762
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/03/2005
Last Update Date : 10/06/2023

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