Individual
DR. TIMOTHY J SHANAHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
522 IDLEWILD AVE, EASTON, MD 21601-3824
(410) 822-5571
(410) 822-3859
Mailing address
522 IDLEWILD AVE, EASTON, MD 21601-3824
(410) 822-5571
(410) 822-3859
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
H0064036
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
H0064036
STATE MEDICAL LICENSE
MD
Enumeration date
07/28/2006
Last updated
07/08/2007
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