Healthcare Provider Details

I. General information

NPI: 1972760452
Provider Name (Legal Business Name): SHANNON COURTNEY O'CONNOR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2008
Last Update Date: 12/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9707 MEDICAL CENTER DR STE 300
ROCKVILLE MD
20850-3365
US

IV. Provider business mailing address

9707 MEDICAL CENTER DR STE 300
ROCKVILLE MD
20850-3365
US

V. Phone/Fax

Practice location:
  • Phone: 301-424-6231
  • Fax:
Mailing address:
  • Phone: 301-424-6231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberD0073109
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: