Provider Demographics
NPI:1184689705
Name:SHEA, PATRICK (MD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:SHEA
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 1:4380 MALSBARY RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-5644
Mailing Address - Country:US
Mailing Address - Phone:513-366-4488
Mailing Address - Fax:513-366-4480
Practice Address - Street 1:10506 MONTGOMERY RD
Practice Address - Street 2:SUITE 504
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-4487
Practice Address - Country:US
Practice Address - Phone:513-792-7800
Practice Address - Fax:513-792-7807
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35058255207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
0647185OtherAETNA
58255-08OtherHUMANA
000000238177OtherANTHEM MIDDLETOWN
IN100335960Medicaid
000000019922OtherANTHEM
OH0741200Medicaid
OH110061530OtherRAILROAD MEDICARE
283910OtherAMERIGROUP
311438871056OtherCARESOURCE
311438871005OtherUNITED
KY64864143Medicaid
OH4087994Medicare PIN
OH0632998Medicare PIN
60032032Medicare ID - Type UnspecifiedRAILROAD
311438871005OtherUNITED
OH110061530OtherRAILROAD MEDICARE
OH0741200Medicaid