Healthcare Provider Details

I. General information

NPI: 1275506487
Provider Name (Legal Business Name): SHANNON VANDERPAS LAMB M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHANNON MICHELE VANDERPAS M.D.

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 12/18/2024
Certification Date: 12/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5255 LOUGHBORO RD NW
WASHINGTON DC
20016-2633
US

IV. Provider business mailing address

6201 GREENLEIGH AVE
MIDDLE RIVER MD
21220-2004
US

V. Phone/Fax

Practice location:
  • Phone: 202-537-4686
  • Fax: 202-537-4965
Mailing address:
  • Phone: 410-933-6423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License NumberFL8368676
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD045663
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberD97920
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number0101236989
License Number StateVA
# 5
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number0101236989
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: