Basic Information
| Provider Information | |||||||||
| NPI: | 1811251499 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHAEFFER | ||||||||
| FirstName: | CATHERINE | ||||||||
| MiddleName: | ANNE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3001 S HANOVER ST | ||||||||
| Address2: | DEPT OF MEDICINE | ||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212251233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103503565 | ||||||||
| FaxNumber: | 4103540186 | ||||||||
| Practice Location | |||||||||
| Address1: | 4500 S GARNETT RD STE 112 | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741465201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9189353550 | ||||||||
| FaxNumber: | 9189353581 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2012 | ||||||||
| LastUpdateDate: | 08/11/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 39381 | OK | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.