Individual
PATRICK L. SHANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
987 BOARDMAN CANFIELD RD, BOARDMAN, OH 44512-4222
(330) 965-8760
(330) 965-9325
Mailing address
987 BOARDMAN CANFIELD RD, BOARDMAN, OH 44512-4222
(330) 965-8760
(330) 965-9325
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
35076264S
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0300914
UNITED HEALTHCARE
OH
01
—
97198
QUALCHOICE
OH
Enumeration date
09/26/2005
Last updated
07/08/2007
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