Provider Demographics
NPI:1730112863
Name:SHAUGHNESSY, CRAIG (MD)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:
Last Name:SHAUGHNESSY
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 1:1816 MIDSUMMER LN
Mailing Address - Street 2:
Mailing Address - City:JARRETTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21084-1200
Mailing Address - Country:US
Mailing Address - Phone:410-557-0064
Mailing Address - Fax:
Practice Address - Street 1:104 PLUMTREE RD
Practice Address - Street 2:SUITE 115
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21015-6095
Practice Address - Country:US
Practice Address - Phone:410-515-4300
Practice Address - Fax:410-515-4318
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0037078207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0403475Medicaid
115227OtherCOVENTRY
0033OtherCAREFIRST DC
026211OtherJOHNS HOPKINS HEALTHCARE
711543OtherNCPPO
7224098OtherAETNA PPO
1980529OtherUNITED HEALTHCARE
2331053OtherAETNA HMO
MD88945Medicaid
9965OtherKAISER
281954OtherMAMSI
3358492OtherCIGNA
44065401OtherCAREFIRST MARYLAND
115227OtherCOVENTRY
MD0403475Medicaid