MEDICARE: DR. JOHN SHAVERS M.D.

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	207R00000X	Internal Medicine Physician	D27838	MD

General Provider Information

NPI Number	:	1134125602
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN SHAVERS M.D.

Provider Business Mailing Address
First Line	:	518 S CAMP MEADE RD
Second Line	:
City	:	LINTHICUM HTS
State	:	MD
Zip	:	21090-2766
Country	:	US
Telephone Number	:	410-859-0355
Fax Number	:	410-859-9183

Provider Business Practice Location Address
First Line	:	518 S CAMP MEADE RD
Second Line	:
City	:	LINTHICUM HTS
State	:	MD
Zip	:	21090-2766
Country	:	US
Telephone Number	:	410-859-0355
Fax Number	:	410-859-9183

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

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	11/11/2009

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