Provider Demographics
NPI:1619958139
Name:SHANNON, WILLIAM BARTHOLOMEW (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:BARTHOLOMEW
Last Name:SHANNON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1061 X RAY DR
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-7489
Mailing Address - Country:US
Mailing Address - Phone:704-861-8557
Mailing Address - Fax:704-853-0003
Practice Address - Street 1:1061 X RAY DR
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-7489
Practice Address - Country:US
Practice Address - Phone:704-861-8557
Practice Address - Fax:704-853-0003
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-10
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC25080207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0933289001OtherCIGNA HEALTHCARE OF NC
NC17924OtherWELLPATH COVENTRY
NC75443OtherBLUE CROSS BLUE SHIELD
AL81047089OtherBCBS OF AL
SC030118OtherBCBS OF SC
NC8975443Medicaid
NC8690OtherPARTNERS NATIONALHEALTH
NC0840038OtherUNITED HEALTHCARE OF NC
2803998OtherAETNA USHC
202449Medicare PIN
NC75443OtherBLUE CROSS BLUE SHIELD