Provider Demographics
NPI:1073625521
Name:SHANNON, CLAUDE K (MD)
Entity Type:Individual
Prefix:DR
First Name:CLAUDE
Middle Name:K
Last Name:SHANNON
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:P. O. BOX 897
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26507-0897
Mailing Address - Country:US
Mailing Address - Phone:304-293-7401
Mailing Address - Fax:304-293-6963
Practice Address - Street 1:1 MEDICAL CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26506
Practice Address - Country:US
Practice Address - Phone:304-598-6900
Practice Address - Fax:304-598-6914
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV12342207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0007709000Medicaid
WV0056507000Medicaid
WVCA9811OtherMEDICARE RAILROAD CARRIER
WVSH0506016OtherPMMG MEDICARE ID
WVPR9255725OtherMEDICARE GROUP NUMBER
WVSH0506016OtherPMMG MEDICARE ID
WV0007709000Medicaid