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NPI Code Detail

MEDICARE: SHANNON SWANSON DO

MEDICARE: SHANNON SWANSON DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207P00000XEmergency Medicine Physician34008887OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000000385522OTHEROHANTHEM
2000000383091OTHEROHANTHEM
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1023067550
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANNON SWANSON DO
Provider Business Mailing Address
First Line : 4535 DRESSLER RD NW
Second Line :
City : CANTON
State : OH
Zip : 44718-2545
Country : US
Telephone Number : 330-493-4443
Fax Number : 330-493-8677
Provider Business Practice Location Address
First Line : 158 W MAIN RD
Second Line :
City : CONNEAUT
State : OH
Zip : 44030-2039
Country : US
Telephone Number : 330-493-4443
Fax Number : 330-493-8677
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/10/2006
Last Update Date : 06/30/2023

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