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NPI Code Detail

MEDICARE: PATRICK L. SHANNON M.D.

MEDICARE: PATRICK L. SHANNON M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialist35076264SOH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
197198OTHEROHQUALCHOICE
20300914OTHEROHUNITED HEALTHCARE

General Provider Information

NPI Number : 1316933260
Entity Type Code : Individual
Provider Name (Legal Business Name) : PATRICK L. SHANNON M.D.
Provider Business Mailing Address
First Line : 987 BOARDMAN CANFIELD RD
Second Line :
City : BOARDMAN
State : OH
Zip : 44512-4222
Country : US
Telephone Number : 330-965-8760
Fax Number : 330-965-9325
Provider Business Practice Location Address
First Line : 987 BOARDMAN CANFIELD RD
Second Line :
City : BOARDMAN
State : OH
Zip : 44512-4222
Country : US
Telephone Number : 330-965-8760
Fax Number : 330-965-9325
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/26/2005
Last Update Date : 07/08/2007

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