MEDICARE: DR. SHANNON LEE HADER MD

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
1	207RI0200X	Infectious Disease Physician	050374	GA
2	208000000X	Pediatrics Physician	050374	GA

General Provider Information

NPI Number	:	1174960637
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHANNON LEE HADER MD

Provider Business Mailing Address
First Line	:	1332 FARRAGUT ST NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20011-6908
Country	:	US
Telephone Number	:	202-290-5106
Fax Number	:

Provider Business Practice Location Address
First Line	:	1332 FARRAGUT ST NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20011-6908
Country	:	US
Telephone Number	:	202-290-5106
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2013
Last Update Date	:	05/23/2013

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Directions to “ DR. SHANNON LEE HADER MD” Practice Location

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