Provider Demographics
NPI:1366856379
Name:FLOOD, SHANE PATRICK (MB BCH BAO)
Entity Type:Individual
Prefix:DR
First Name:SHANE
Middle Name:PATRICK
Last Name:FLOOD
Suffix:
Gender:M
Credentials:MB BCH BAO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:KILPATRICK
Mailing Address - Street 2:BUNBROSNA
Mailing Address - City:MULLINGAR
Mailing Address - State:WESTMEATH
Mailing Address - Zip Code:0000
Mailing Address - Country:IE
Mailing Address - Phone:267-992-9442
Mailing Address - Fax:
Practice Address - Street 1:800 SPRUCE ST
Practice Address - Street 2:PENNSYLVANIA HOSPITAL, DEPARTMENT OF INTERNAL MEDICINE
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-6130
Practice Address - Country:US
Practice Address - Phone:215-829-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-17
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT207461207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine