MEDICARE: DR. WILLIAM SHORE

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	103T00000X	Psychologist	2282	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	001089	OTHER	MD	VALUE OPTIONS
2	H1630001	OTHER	DC	BLUE CROSS
3	412350	OTHER	MD	MAMSI/ALLIANCE
4	2282	OTHER	MD	KAISER
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	458821000	OTHER	MD	MAGELLAN
7	52475204	OTHER	MD	BLUE CROSS

General Provider Information

NPI Number	:	1487650404
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM SHORE

Provider Business Mailing Address
First Line	:	3720 FARRAGUT AVE
Second Line	:	STE 103
City	:	KENSINGTON
State	:	MD
Zip	:	20895-2110
Country	:	US
Telephone Number	:	301-934-8811
Fax Number	:	301-934-9321

Provider Business Practice Location Address
First Line	:	3720 FARRAGUT AVE
Second Line	:	STE 103
City	:	KENSINGTON
State	:	MD
Zip	:	20895-2110
Country	:	US
Telephone Number	:	301-934-8811
Fax Number	:	301-934-9321

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

Provider Enumeration Date	:	06/23/2005
Last Update Date	:	07/09/2007

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Directions to “ DR. WILLIAM SHORE ” Practice Location

Language	Start Address	Practice Location

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