1033520226 NPI number — DR. SHANE PATRICK HENNESSY D.O.

Table of content: DR. SHANE PATRICK HENNESSY D.O. (NPI 1033520226)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033520226 NPI number — DR. SHANE PATRICK HENNESSY D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HENNESSY
Provider First Name:
SHANE
Provider Middle Name:
PATRICK
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

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:
1033520226
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/02/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 PLAZA DR
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
BELLE VERNON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15012-4019
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-379-5816
Provider Business Mailing Address Fax Number:
724-379-5874

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 PLAZA DR STE 400
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELLE VERNON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-379-5816
Provider Business Practice Location Address Fax Number:
724-379-5813
Provider Enumeration Date:
05/11/2014

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: 207QS0010X , with the licence number:  OS018852 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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