Provider Demographics
NPI:1467596775
Name:SHANNON, STEVEN RALPH (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:RALPH
Last Name:SHANNON
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 1:2305 APRICOT ARBOR PL
Mailing Address - Street 2:
Mailing Address - City:ODENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21113-2530
Mailing Address - Country:US
Mailing Address - Phone:410-672-7301
Mailing Address - Fax:
Practice Address - Street 1:7830 OLD GEORGETOWN RD
Practice Address - Street 2:SUITE C-15
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-2432
Practice Address - Country:US
Practice Address - Phone:301-656-0220
Practice Address - Fax:301-654-0333
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD34241208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDI08017Medicare UPIN