Provider Demographics
NPI:1982606794
Name:WEST, SHANNON L (MD)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:L
Last Name:WEST
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1111 BENFIELD BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MILLERSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21108-3002
Mailing Address - Country:US
Mailing Address - Phone:410-729-5100
Mailing Address - Fax:410-729-5156
Practice Address - Street 1:1509 RITCHIE HWY
Practice Address - Street 2:
Practice Address - City:ARNOLD
Practice Address - State:MD
Practice Address - Zip Code:21012-2742
Practice Address - Country:US
Practice Address - Phone:410-757-7600
Practice Address - Fax:410-626-8043
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2011-01-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD0057448208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD015296OtherJHHC PRIORITY PARTNERS
MD613036-05OtherCAREFIRST BCBS OF MARYLAND
MD776200300Medicaid
MD8224818OtherMAMSI
MD0104OtherCAREFIRST BCBS- BLUE CHOICE
MDP18945OtherCAREFIRST BCBS POS
MD7510271OtherAETNA HMO
MD6063361OtherAETNA- PPO
MDP18945OtherCAREFIRST BCBS POS