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NPI Code Detail

MEDICARE: MICHAEL S DESHIELDS M.D.

MEDICARE: MICHAEL S DESHIELDS 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
1207RA0401XAddiction Medicine (Internal Medicine) Physician25MA04362400NJ
2251K00000XPublic Health or Welfare Agency25MA04362400NJ

Other Identifiers

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

General Provider Information

NPI Number : 1245345743
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL S DESHIELDS M.D.
Provider Business Mailing Address
First Line : 20 N WOODBURY TURNERSVILLE RD
Second Line :
City : BLACKWOOD
State : NJ
Zip : 08012-2888
Country : US
Telephone Number : 856-374-6740
Fax Number : 856-374-6520
Provider Business Practice Location Address
First Line : 801 NEW YORK AVE
Second Line :
City : TRENTON
State : NJ
Zip : 08638-3913
Country : US
Telephone Number : 609-393-8000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/21/2006
Last Update Date : 07/03/2019

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