Individual
SHANNON PETUKHOV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2001 MEDICAL PKWY, ANNAPOLIS, MD 21401-3773
(443) 481-1366
Mailing address
110 SOUTH PACA STREET 6 FL. SUITE 200, BALTIMORE, MD 21201-1645
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
D0087812
MD
Other
Enumeration date
04/14/2016
Last updated
02/06/2020
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