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General NPI Number Information
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NPI Number | 1467596775
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Entity Type | Individual
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Provider Name | STEVEN RALPH SHANNON MD
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Gender | Male
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Dates
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Enumeration Date | 02/19/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 7830 OLD GEORGETOWN RD SUITE C-15
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City | BETHESDA
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State | MD
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Zip | 20814-2432
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Country | US
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Telephone | 301-656-0220
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Fax | 301-654-0333
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Provider Business Mailing Address
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Address Line | 2305 APRICOT ARBOR PL
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City | ODENTON
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State | MD
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Zip | 21113-2530
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Country | US
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Telephone | 410-672-7301
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Fax |
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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 | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | D34241
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License Number State | MD
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