Provider Demographics
NPI:1235133018
Name:FINCH, SHANNON (M D)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:FINCH
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1318 EUCLID AVE
Mailing Address - Street 2:SUITE 2-3
Mailing Address - City:BRISTOL
Mailing Address - State:VA
Mailing Address - Zip Code:24201-3830
Mailing Address - Country:US
Mailing Address - Phone:276-466-0744
Mailing Address - Fax:276-466-1628
Practice Address - Street 1:1318 EUCLID AVE
Practice Address - Street 2:SUITE 2-3
Practice Address - City:BRISTOL
Practice Address - State:VA
Practice Address - Zip Code:24201-3830
Practice Address - Country:US
Practice Address - Phone:276-466-0744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-09
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101223610207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3865253Medicaid
VA5605784Medicaid
TN080173590Medicare PIN
H40423Medicare UPIN
TN3865253Medicare ID - Type Unspecified
VA5605784Medicaid
0281780001Medicare PIN
VAV V2198AMedicare PIN
0281780003Medicare PIN
TN3865253Medicaid
TNCA5023Medicare PIN