MEDICARE: LAURENCE MARION DESHIELDS 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	208M00000X	Hospitalist Physician	37837	IA
2	207Q00000X	Family Medicine Physician	0101244369	VA

General Provider Information

NPI Number	:	1861411084
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURENCE MARION DESHIELDS MD

Provider Business Mailing Address
First Line	:	820 S COLUMBUS ST UNIT 106
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22314-4293
Country	:	US
Telephone Number	:	202-230-2811
Fax Number	:

Provider Business Practice Location Address
First Line	:	820 S COLUMBUS ST
Second Line	:	#106
City	:	ALEXANDRIA
State	:	VA
Zip	:	22314-4289
Country	:	US
Telephone Number	:	202-230-2811
Fax Number	:

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

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	12/02/2025

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