MEDICARE: DR. KATHRYN THERESE SHAHWAN 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	207N00000X	Dermatology Physician	35.143817	OH
2	207ND0101X	MOHS-Micrographic Surgery Physician	35.143817	OH

General Provider Information

NPI Number	:	1699193714
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHRYN THERESE SHAHWAN MD

Provider Business Mailing Address
First Line	:	700 ACKERMAN RD STE 2120
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43202-1559
Country	:	US
Telephone Number	:	614-293-0404
Fax Number	:	614-366-7147

Provider Business Practice Location Address
First Line	:	2050 KENNY RD FL 4
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43221-3502
Country	:	US
Telephone Number	:	614-293-0404
Fax Number	:	614-366-7147

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

Provider Enumeration Date	:	04/05/2014
Last Update Date	:	01/12/2026

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