DR. MD Mary Kelly Shanahan, NPI 1588661359
Obstetrics & Gynecology Physician in South Lake Tahoe, CA, US

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NPI number: what is it?

The NPI, or National Provider Identifier, is a non-repeatable number for health care providers. The NPI always consists of 10 digits and is used for administrative and financial procedures. The NPI wa...

NPI 1588661359
NPI Entity Type Individual
Provider Name DR. MD Mary Kelly Shanahan
Enumeration Date September 30, 2009
Last Update Date September 30, 2009
Provider Location Address 1154 Emerald Bay Rd, South Lake Tahoe, CA, US
Provider Mailing Address 1154 Emerald Bay Rd, South Lake Tahoe, CA, US, 961506288
Is Sole Proprietor? Yes
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Primary Taxonomy

Taxonomy Code

207V00000X

Taxonomy Name Obstetrics & Gynecology Physician
Classification

Obstetrics & Gynecology

Group

Allopathic & Osteopathic Physicians

License No. G78582
License State CA
Description An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women.

Business Address

DR. MD Mary Kelly Shanahan
1154 Emerald Bay Rd

South Lake Tahoe, CA, US

Phone: 530-542-4961
Fax: 530-542-4964

Mailing Address

DR. MD Mary Kelly Shanahan
1154 Emerald Bay Rd
South Lake Tahoe, CA, US
ZIP 961506288
Phone: 530-542-4961
Fax: 530-542-4964

Secondary Taxonomies

Taxonomy Code Group Classification License No. State Primary?

207V00000X

Allopathic & Osteopathic Physicians

Obstetrics & Gynecology

7055 NV No

Other Identifiers

Identifier Identifier State Identifier Issuer Type/Code
1588661359 CA MEDICAID 05
1588661359 NV MEDICAID 05

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