Individual
SHANE P MCTIGHE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
6600 VAN AALST BLVD, FORT BENNING, GA 31905-2102
(762) 408-3384
(762) 408-8113
Mailing address
8901 ROCKVILLE PIKE WRNMMC ATTN: GME, BETHESDA, MD 20889-0001
(301) 295-4551
(301) 295-9736
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
Q9194
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/19/2015
Last updated
08/05/2022
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