MEDICARE: DR. SHANNON R GINNAN 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
1	208D00000X	General Practice Physician	0101231928	VA

General Provider Information

NPI Number	:	1487839080
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHANNON R GINNAN M.D.

Provider Business Mailing Address
First Line	:	1934 OLD GALLOWS RD
Second Line	:	SUITE 500
City	:	VIENNA
State	:	VA
Zip	:	22182-4042
Country	:	US
Telephone Number	:	703-677-3200
Fax Number	:	703-677-3201

Provider Business Practice Location Address
First Line	:	1934 OLD GALLOWS RD
Second Line	:	SUITE 500
City	:	VIENNA
State	:	VA
Zip	:	22182-4042
Country	:	US
Telephone Number	:	703-677-3200
Fax Number	:	703-677-3201

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

Provider Enumeration Date	:	01/02/2008
Last Update Date	:	09/27/2013

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