Provider Demographics
NPI:1124061643
Name:SHEPARD, ERIC (MD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:
Last Name:SHEPARD
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:PO BOX 64374
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4374
Mailing Address - Country:US
Mailing Address - Phone:410-328-6720
Mailing Address - Fax:410-328-1674
Practice Address - Street 1:110 S PACA ST
Practice Address - Street 2:SUITE 300 6TH FL
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1642
Practice Address - Country:US
Practice Address - Phone:410-328-6720
Practice Address - Fax:410-328-1674
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0047484207LC0200X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD371371700Medicaid
MDCA8702OtherRAILROAD MEDICARE GROUP
MD85FFMedicare ID - Type Unspecified
MD371371700Medicaid
MDF972Medicare PIN
MDCA8702Medicare PIN
MDF53711Medicare UPIN
MD050078236Medicare UPIN
MD86FFMedicare ID - Type Unspecified
MD85FFMedicare PIN