1982606794 NPI number — DR. SHANNON L WEST MD

Table of content: DR. SHANNON L WEST MD (NPI 1982606794)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982606794 NPI number — DR. SHANNON L WEST MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEST
Provider First Name:
SHANNON
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982606794
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/24/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1111 BENFIELD BLVD
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
MILLERSVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21108-3002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-729-5100
Provider Business Mailing Address Fax Number:
410-729-5156

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1509 RITCHIE HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARNOLD
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21012-2742
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-757-7600
Provider Business Practice Location Address Fax Number:
410-626-8043
Provider Enumeration Date:
08/11/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  D0057448 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 015296 . This is a "JHHC PRIORITY PARTNERS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 613036-05 . This is a "CAREFIRST BCBS OF MARYLAND" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 776200300 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8224818 . This is a "MAMSI" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 0104 . This is a "CAREFIRST BCBS- BLUE CHOICE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: P18945 . This is a "CAREFIRST BCBS POS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 7510271 . This is a "AETNA HMO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 6063361 . This is a "AETNA- PPO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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