Provider Demographics
NPI:1649766429
Name:CLARK, SHAWNESE GILPIN (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:SHAWNESE
Middle Name:GILPIN
Last Name:CLARK
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:SHAWNESE
Other - Middle Name:LAUREN SAMANTHA
Other - Last Name:GILPIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, MPH
Mailing Address - Street 1:3400 POTOMAC AVE APT 907
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22202-4083
Mailing Address - Country:US
Mailing Address - Phone:240-506-8967
Mailing Address - Fax:
Practice Address - Street 1:7503 SURRATTS RD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-3358
Practice Address - Country:US
Practice Address - Phone:240-506-8967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-05
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD210001555208000000X
MDD91831208M00000X
MDD0091831208000000X
IL125.073399208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist