Provider Demographics
NPI:1679512503
Name:SHEVITZ, DAVID L (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:L
Last Name:SHEVITZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:3811 TABOR RD
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-1245
Mailing Address - Country:US
Mailing Address - Phone:443-604-4383
Mailing Address - Fax:410-889-9404
Practice Address - Street 1:3811 CANTERBURY RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-2340
Practice Address - Country:US
Practice Address - Phone:443-604-4383
Practice Address - Fax:410-889-3616
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00436922084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD182441400Medicaid
MD260036595OtherR/R MEDICARE PROVIDER #
MDCC3779OtherR/R MEDICARE GROUP #
MD260036595OtherR/R MEDICARE PROVIDER #
MDS582898VMedicare PIN