Provider Demographics
NPI:1699193714
Name:SHAHWAN, KATHRYN THERESE (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:THERESE
Last Name:SHAHWAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:THERESE
Other - Last Name:KOENIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-293-0404
Mailing Address - Fax:614-366-7147
Practice Address - Street 1:2050 KENNY RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-3502
Practice Address - Country:US
Practice Address - Phone:614-293-0404
Practice Address - Fax:614-366-7147
Is Sole Proprietor?:No
Enumeration Date:2014-04-05
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.143817207N00000X, 207ND0101X
MN60894207N00000X
MA264341207N00000X
ND17530207N00000X
IL125064553207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine