Provider Demographics
NPI:1366569899
Name:O'MAHAR, SHANNON E (MD)
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:E
Last Name:O'MAHAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1200 JOHN Q HAMMONS DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53717-1959
Mailing Address - Country:US
Mailing Address - Phone:608-410-2700
Mailing Address - Fax:608-410-2905
Practice Address - Street 1:1200 JOHN Q HAMMONS DR
Practice Address - Street 2:SUITE 400
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53717-1959
Practice Address - Country:US
Practice Address - Phone:608-410-2700
Practice Address - Fax:608-410-2905
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI52434-020207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1366569899Medicaid
WI61331OtherDEAN HEALTH INSURANCE
WIP001177589Medicare PIN
WI741501938Medicare PIN