1730112863 NPI number — DR. CRAIG SHAUGHNESSY M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730112863 NPI number — DR. CRAIG SHAUGHNESSY M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

SHAUGHNESSY

Provider First Name:

CRAIG

Provider Middle Name:

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

M

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:

1730112863

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

07/09/2007

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

1816 MIDSUMMER LN

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

JARRETTSVILLE

Provider Business Mailing Address State Name:

MD

Provider Business Mailing Address Postal Code:

21084-1200

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

410-557-0064

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

104 PLUMTREE RD

Provider Second Line Business Practice Location Address:

SUITE 115

Provider Business Practice Location Address City Name:

BEL AIR

Provider Business Practice Location Address State Name:

MD

Provider Business Practice Location Address Postal Code:

21015-6095

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

410-515-4300

Provider Business Practice Location Address Fax Number:

410-515-4318

Provider Enumeration Date:

07/09/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207R00000X , with the licence number:  D0037078 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 0403475 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
• Identifier: 115227 . This is a "COVENTRY" identifier . This identifiers is of the category "OTHER".
• Identifier: 0033 . This is a "CAREFIRST DC" identifier . This identifiers is of the category "OTHER".
• Identifier: 026211 . This is a "JOHNS HOPKINS HEALTHCARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 711543 . This is a "NCPPO" identifier . This identifiers is of the category "OTHER".
• Identifier: 7224098 . This is a "AETNA PPO" identifier . This identifiers is of the category "OTHER".
• Identifier: 1980529 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 2331053 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
• Identifier: 88945 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
• Identifier: 9965 . This is a "KAISER" identifier . This identifiers is of the category "OTHER".
• Identifier: 281954 . This is a "MAMSI" identifier . This identifiers is of the category "OTHER".
• Identifier: 3358492 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
• Identifier: 44065401 . This is a "CAREFIRST MARYLAND" identifier . This identifiers is of the category "OTHER".