Provider Demographics
NPI:1194887307
Name:HURWITZ, SHEPARD R (MD)
Entity type:Individual
Prefix:
First Name:SHEPARD
Middle Name:R
Last Name:HURWITZ
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 1:143 W FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27516-2539
Mailing Address - Country:US
Mailing Address - Phone:919-966-7130
Mailing Address - Fax:919-966-6730
Practice Address - Street 1:143 W FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27516-2539
Practice Address - Country:US
Practice Address - Phone:919-966-7130
Practice Address - Fax:919-966-6730
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101050739207XX0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006401716Medicaid
VA006401716Medicaid
VAC61926Medicare UPIN