Provider Demographics
NPI:1861411084
Name:DESHIELDS, LAURENCE MARION (MD)
Entity type:Individual
Prefix:
First Name:LAURENCE
Middle Name:MARION
Last Name:DESHIELDS
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 1:820 S COLUMBUS ST
Mailing Address - Street 2:#106
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-4289
Mailing Address - Country:US
Mailing Address - Phone:202-230-2811
Mailing Address - Fax:
Practice Address - Street 1:820 S COLUMBUS ST
Practice Address - Street 2:#106
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-4289
Practice Address - Country:US
Practice Address - Phone:202-230-2811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD420043207Q00000X
IA37837208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine