Basic Information
| Provider Information | |||||||||
| NPI: | 1851516165 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHANNON | ||||||||
| FirstName: | CLARENCE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | IV | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3818 MONTROSE DRIVEWAY | ||||||||
| Address2: | |||||||||
| City: | CHEVY CHASE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208154702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3016568772 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6900 GEORGIA AVE, NW , WARD 44 | ||||||||
| Address2: | WRAMC DEPARTMENT OF SURGERY | ||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 203075001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2027820039 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 044586 | GA | X | Allopathic & Osteopathic Physicians | Anesthesiology | 207LP2900X | 044586 | GA | X | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
No ID Information.