Provider Demographics
NPI:1043394901
Name:SHANAHAN, JOSEPH CHARLES (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:CHARLES
Last Name:SHANAHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 E NC HIGHWAY 54 STE 200
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-5271
Mailing Address - Country:US
Mailing Address - Phone:919-405-2040
Mailing Address - Fax:919-405-2266
Practice Address - Street 1:2222 E NC HIGHWAY 54 STE 200
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-5271
Practice Address - Country:US
Practice Address - Phone:919-405-2040
Practice Address - Fax:919-405-2266
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC98-01767207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890138JMedicaid
NCH35750Medicare UPIN
NC2312411Medicare PIN
NC1277990001Medicare NSC