Individual provider · NPI-1

Dr. Tristan J Shockley, MD

Physical Medicine & Rehabilitation · Laurel, MD

NPI number1932242542
StatusActive
Last updated in NPPESJun 30, 2021

Details

NPI
1932242542
Entity type
Individual (NPI-1)
Name
Dr. Tristan J Shockley
Credential
MD
Sex
Male
Sole proprietor
No
Enumeration date
Feb 14, 2007
Certification date
Jun 30, 2021
Last updated
Jun 30, 2021

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
208100000X Physical Medicine & RehabilitationD0068884MDYes
208100000X Physical Medicine & RehabilitationMD038330DC

Practice location

14205 Park Center Dr
Suite 204
Laurel, MD 20707-5246

Phone 240-786-1001

Mailing address

9900 Greenbelt Rd
Suite E117
Lanham, MD 20706-2255

Phone 240-786-1001

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