MEDICARE: DR. SHANNON M MCDONNELL 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	207P00000X	Emergency Medicine Physician	0101232200	VA

General Provider Information

NPI Number	:	1477523066
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHANNON M MCDONNELL MD

Provider Business Mailing Address
First Line	:	111 BULIFANTS BLVD
Second Line	:	SUITE B
City	:	WILLIAMSBURG
State	:	VA
Zip	:	23188-5711
Country	:	US
Telephone Number	:	757-941-6000
Fax Number	:	757-221-8085

Provider Business Practice Location Address
First Line	:	100 SENTARA CIRCLE
Second Line	:
City	:	WILLIAMSBURG
State	:	VA
Zip	:	23188-5713
Country	:	US
Telephone Number	:	757-984-6000
Fax Number	:

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

Provider Enumeration Date	:	01/25/2006
Last Update Date	:	08/11/2011

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