1619302478 NPI number — MRS. SHANNON ROSE BRIGHAM PA-C

Table of content: MRS. SHANNON ROSE BRIGHAM PA-C (NPI 1619302478)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619302478 NPI number — MRS. SHANNON ROSE BRIGHAM PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRIGHAM
Provider First Name:
SHANNON
Provider Middle Name:
ROSE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FUHR
Provider Other First Name:
SHANNON
Provider Other Middle Name:
ROSE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1619302478
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/20/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20010 CENTURY BLVD, SUITE 200
Provider Second Line Business Mailing Address:
EMERGENCY MEDICINE ASSOCIATES
Provider Business Mailing Address City Name:
GERMANTOWN
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20874
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
240-686-2300
Provider Business Mailing Address Fax Number:
240-686-2330

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8118 GOOD LUCK ROAD
Provider Second Line Business Practice Location Address:
DOCTORS COMMUNITY HOSPITAL
Provider Business Practice Location Address City Name:
LANHAM
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-552-8686
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/11/2013

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: 363A00000X , with the licence number:  C05192 , 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)





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