Provider Demographics
NPI:1265449441
Name:SHANNON, MARGARET M (MD)
Entity Type:Individual
Prefix:DR
First Name:MARGARET
Middle Name:M
Last Name:SHANNON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:275 VICTORIA ST
Mailing Address - Street 2:SUITE 1H
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-1906
Mailing Address - Country:US
Mailing Address - Phone:949-646-2311
Mailing Address - Fax:949-646-1064
Practice Address - Street 1:275 VICTORIA ST
Practice Address - Street 2:SUITE 1H
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-1906
Practice Address - Country:US
Practice Address - Phone:949-646-2311
Practice Address - Fax:949-646-1064
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG42251207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG42251Medicare ID - Type Unspecified