Provider Demographics
NPI:1184689705
Name:SHEA, PATRICK (MD)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:SHEA
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 1:10506A MONTGOMERY RD
Mailing Address - Street 2:STE 301
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-4400
Mailing Address - Country:US
Mailing Address - Phone:513-246-2400
Mailing Address - Fax:
Practice Address - Street 1:10506A MONTGOMERY RD
Practice Address - Street 2:STE 301
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-4400
Practice Address - Country:US
Practice Address - Phone:513-246-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35058255207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000238177OtherANTHEM MIDDLETOWN
OH0741200Medicaid
IN100335960Medicaid
311438871005OtherUNITED
311438871056OtherCARESOURCE
000000019922OtherANTHEM
0647185OtherAETNA
OH110061530OtherRAILROAD MEDICARE
283910OtherAMERIGROUP
58255-08OtherHUMANA
KY64864143Medicaid
OH4087994Medicare PIN
OH0632998Medicare PIN
60032032Medicare ID - Type UnspecifiedRAILROAD
311438871005OtherUNITED
OH110061530OtherRAILROAD MEDICARE
OH0741200Medicaid