Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 27945 | MA |
N | 2080P0214X | Pediatric Pulmonologist | 27945 | MA |
NPI | 1609857879 |
---|---|
Provider Name | Dr. Daniel Charles Shannon |
First Address | Charlestown, MA 02129-9142 |
Second Address | Boston, MA 02114 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0179663 | (05) | MA |
027945 | TUFTS HEALTH PLAN (01) | MA |
A53927 | (02) | |
C26019 | BCBS MA (01) | MA |