Provider Demographics
NPI:1124167788
Name:SHANNON KEARNEY, DO, PC
Entity type:Organization
Organization Name:SHANNON KEARNEY, DO, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:KEARNEY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:610-867-8874
Mailing Address - Street 1:3535 HIGH POINT BLVD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-7804
Mailing Address - Country:US
Mailing Address - Phone:610-867-8874
Mailing Address - Fax:610-867-8871
Practice Address - Street 1:3535 HIGH POINT BLVD
Practice Address - Street 2:SUITE 600
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-7804
Practice Address - Country:US
Practice Address - Phone:610-867-8874
Practice Address - Fax:610-867-8871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS 011819207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAOS 011819OtherMEDICAL LICENCE
087996KXLMedicare ID - Type Unspecified
PAOS 011819OtherMEDICAL LICENCE