Provider Demographics
NPI:1497746275
Name:TWEEDT, SHAWN MICHAEL (DO)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:MICHAEL
Last Name:TWEEDT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18109 PRINCE PHILIP DR STE B100
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-1607
Mailing Address - Country:US
Mailing Address - Phone:301-774-8962
Mailing Address - Fax:855-778-6897
Practice Address - Street 1:18109 PRINCE PHILIP DR STE B100
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-1607
Practice Address - Country:US
Practice Address - Phone:301-774-8962
Practice Address - Fax:855-778-6897
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH0063192208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD003488600Medicaid
MDG02091M01Medicare ID - Type Unspecified
MDI42046Medicare UPIN
MD003488600Medicaid