MEDICARE: DR. WILLIAM SHEVIN 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
1	208D00000X	General Practice Physician	CT021770	CT

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	010057604	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CT5191	OTHER		HEALTHNET
3	782878	OTHER		CONNECTICARE
4	010021770CT01	OTHER	CT	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1629168059
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM SHEVIN MD

Provider Business Mailing Address
First Line	:	50 APPLEWOOD DR
Second Line	:
City	:	WOODSTOCK
State	:	CT
Zip	:	06281
Country	:	US
Telephone Number	:	860-928-4040
Fax Number	:	860-928-0733

Provider Business Practice Location Address
First Line	:	50 APPLEWOOD DR
Second Line	:
City	:	WOODSTOCK
State	:	CT
Zip	:	06281
Country	:	US
Telephone Number	:	860-928-4040
Fax Number	:	860-928-0733

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

Provider Enumeration Date	:	10/14/2006
Last Update Date	:	12/15/2009

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Directions to “ DR. WILLIAM SHEVIN MD” Practice Location

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