Provider Demographics
NPI:1326083379
Name:SHAUGHNESSY, THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:
Last Name:SHAUGHNESSY
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 1:4600 MONTGOMERY RD
Mailing Address - Street 2:STE 105
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-2697
Mailing Address - Country:US
Mailing Address - Phone:513-487-5305
Mailing Address - Fax:513-487-5317
Practice Address - Street 1:830 THOMAS MORE PKWY STE 202
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017-5103
Practice Address - Country:US
Practice Address - Phone:859-341-6281
Practice Address - Fax:859-341-4661
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-053140207RN0300X
KY21833207RN0300X
IN01034872207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0642611Medicaid
OH0642611Medicaid
KY0514408Medicare PIN
OH0589324Medicare PIN