Provider Demographics
NPI:1487839080
Name:GINNAN, SHANNON R (MD)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:R
Last Name:GINNAN
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 1:1934 OLD GALLOWS RD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-4042
Mailing Address - Country:US
Mailing Address - Phone:703-677-3200
Mailing Address - Fax:703-677-3201
Practice Address - Street 1:1934 OLD GALLOWS RD
Practice Address - Street 2:SUITE 500
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-4042
Practice Address - Country:US
Practice Address - Phone:703-677-3200
Practice Address - Fax:703-677-3201
Is Sole Proprietor?:No
Enumeration Date:2008-01-02
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101231928208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice