Provider Demographics
NPI:1922096684
Name:MCSHANNIC, JOSEPH R (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:R
Last Name:MCSHANNIC
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 1:95 ARCH ST
Mailing Address - Street 2:SUITE 215
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44304-1437
Mailing Address - Country:US
Mailing Address - Phone:330-434-4145
Mailing Address - Fax:330-375-4985
Practice Address - Street 1:95 ARCH ST
Practice Address - Street 2:SUITE 215
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44304-1437
Practice Address - Country:US
Practice Address - Phone:330-434-4145
Practice Address - Fax:330-375-4985
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350626652086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0326374Medicaid
OH0845563Medicaid
OHMCO821991Medicare ID - Type UnspecifiedINDIVIDUAL MEDICARE NUMBE
OH0326374Medicaid
OHAK9934611Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER