Provider Demographics
NPI:1932303922
Name:KNAPP, SHANNON STOUT (MD)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:STOUT
Last Name:KNAPP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3399 STRAUSS AVE
Mailing Address - Street 2:
Mailing Address - City:INDIAN HEAD
Mailing Address - State:MD
Mailing Address - Zip Code:20640-5164
Mailing Address - Country:US
Mailing Address - Phone:757-314-0714
Mailing Address - Fax:
Practice Address - Street 1:3399 STRAUSS AVE
Practice Address - Street 2:
Practice Address - City:INDIAN HEAD
Practice Address - State:MD
Practice Address - Zip Code:20640-5164
Practice Address - Country:US
Practice Address - Phone:301-744-1057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101252227207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine