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General NPI Number Information
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NPI Number | 1770727836
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Entity Type | Individual
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Provider Name | SHANNON LEIGH CARPENTER M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/20/2009
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Last Update Date | 08/03/2018
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Provider Practice Location Address
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Address Line | 12 KANAWHA TER
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City | SAINT ALBANS
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State | WV
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Zip | 25177
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Country | US
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Telephone | 304-201-1130
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Fax | 304-201-1134
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Provider Business Mailing Address
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Address Line | 3200 MACCORKLE AVE SE SUITE B16
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City | CHARLESTON
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State | WV
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Zip | 25304
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Country | US
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Telephone | 304-388-5848
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Fax | 304-388-9654
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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 | 24882
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 24882
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License Number State | WV
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