MEDICARE: DR. SHANNON MARIE WENTWORTH MD

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
1	207V00000X	Obstetrics & Gynecology Physician	MD210002010	DC

General Provider Information

NPI Number	:	1447756416
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHANNON MARIE WENTWORTH MD

Provider Business Mailing Address
First Line	:	2041 GEORGIA AVENUE NW, SUITE 3400
Second Line	:	HOWARD UNIVERSITY FACULTY PRACTICE PLAN
City	:	WASHINGTON
State	:	DC
Zip	:	20060-1502
Country	:	US
Telephone Number	:	202-865-6679
Fax Number	:

Provider Business Practice Location Address
First Line	:	2041 GEORGIA AVENUE NW
Second Line	:	FIRST FLOOR, SUITE B
City	:	WASHINGTON
State	:	DC
Zip	:	20060-2006
Country	:	US
Telephone Number	:	202-865-6679
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/30/2018
Last Update Date	:	03/13/2023

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