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NPI Code Detail

MEDICARE: SHANNON MICHELLE NOVOSAD VERMA M.D.

MEDICARE: SHANNON MICHELLE NOVOSAD VERMA 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
1207N00000XDermatology Physician35.090812OH

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
4P00640612OTHEROHRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12130350OTHEROHCIGNA
29624134OTHEROHAETNA
3000000571667OTHEROHANTHEM BC/BS
52927826OTHEROHUNITED HEALTHCARE
61900423OTHEROHCOVENTRY HEALTH

General Provider Information

NPI Number : 1689771933
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANNON MICHELLE NOVOSAD VERMA M.D.
Provider Business Mailing Address
First Line : 10708 COUNTRY WALK CT.
Second Line :
City : CENTERVILLE
State : OH
Zip : 45458
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5300 FAR HILLS AVENUE
Second Line :
City : DAYTON
State : OH
Zip : 45429-2347
Country : US
Telephone Number : 937-433-7536
Fax Number : 937-433-9612
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2006
Last Update Date : 08/03/2016

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Directions to “ SHANNON MICHELLE NOVOSAD VERMA M.D.” Practice Location

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