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General NPI Number Information
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NPI Number | 1336278894
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Entity Type | Individual
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Provider Name | SHANNON K BOLON MD
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Gender | Female
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Dates
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Enumeration Date | 03/02/2007
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Last Update Date | 06/18/2008
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Provider Practice Location Address
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Address Line | 301 11TH ST SUITE C
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City | NEW KENSINGTON
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State | PA
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Zip | 15068-6179
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Country | US
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Telephone | 724-334-3640
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Fax | 724-334-3644
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Provider Business Mailing Address
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Address Line | UNIV OF CINCINNATI DEPART OF FAMILY MEDICINE P.O. BOX 670582
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City | CINCINNATI
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State | OH
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Zip | 45267-0001
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Country | US
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Telephone | 513-558-1430
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Fax | 513-558-3266
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD430353
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License Number State | PA
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