Provider Demographics
NPI:1770997181
Name:SHANKAR C. NAGANNA MD PA
Entity type:Organization
Organization Name:SHANKAR C. NAGANNA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:SADOWSKI
Authorized Official - Last Name:NAGANNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-289-8286
Mailing Address - Street 1:686 A POOLE ROAD
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-6177
Mailing Address - Country:US
Mailing Address - Phone:443-289-8286
Mailing Address - Fax:443-289-8295
Practice Address - Street 1:686 A POOLE ROAD
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-6177
Practice Address - Country:US
Practice Address - Phone:443-289-8286
Practice Address - Fax:443-289-8295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-13
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0059552261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD7496418OtherAETNA
MD1840995OtherCIGNA
MD7496418OtherAETNA