Provider Demographics
NPI:1275512253
Name:SHANAHAN, PATRICK JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:JOSEPH
Last Name:SHANAHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:120 SPEER RD
Mailing Address - Street 2:BLDG B
Mailing Address - City:CHESTERTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21620-1044
Mailing Address - Country:US
Mailing Address - Phone:410-778-9300
Mailing Address - Fax:410-778-9579
Practice Address - Street 1:120 SPEER RD
Practice Address - Street 2:BLDG B
Practice Address - City:CHESTERTOWN
Practice Address - State:MD
Practice Address - Zip Code:21620-1044
Practice Address - Country:US
Practice Address - Phone:410-778-9300
Practice Address - Fax:410-778-9579
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0036054207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD545541300Medicaid
MD545541300Medicaid
621L117DMedicare PIN