Provider Demographics
NPI:1902096050
Name:SHEPHERD, JONATHAN JOEL (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:JOEL
Last Name:SHEPHERD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:18 BRETON HILL RD
Mailing Address - Street 2:APT. #3B
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-2716
Mailing Address - Country:US
Mailing Address - Phone:312-391-7437
Mailing Address - Fax:
Practice Address - Street 1:6707 WHITESTONE RD
Practice Address - Street 2:SUITE 106
Practice Address - City:WOODLAWN
Practice Address - State:MD
Practice Address - Zip Code:21207-4106
Practice Address - Country:US
Practice Address - Phone:410-265-8737
Practice Address - Fax:410-265-1258
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-25
Last Update Date:2012-02-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD00705382084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry