Provider Demographics
NPI:1871542274
Name:SHEPPERD, SCOTT D (MD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:D
Last Name:SHEPPERD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 IRVING ST NW
Mailing Address - Street 2:#2A38
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010-2976
Mailing Address - Country:US
Mailing Address - Phone:202-877-2848
Mailing Address - Fax:202-877-6292
Practice Address - Street 1:110 IRVING ST NW
Practice Address - Street 2:#2A38
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-2976
Practice Address - Country:US
Practice Address - Phone:202-877-2848
Practice Address - Fax:202-877-6292
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD19404207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5865506Medicaid
VA5865506Medicaid
DC177863I17Medicare ID - Type Unspecified