Basic Information
Provider Information
NPI: 1073711669
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ORR
FirstName: SHANNON
MiddleName: RENEE
NamePrefix:  
NameSuffix:  
Credential: DO
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 200 LOTHROP ST
Address2: FORBES TOWER ROOM 9055
City: PITTSBURGH
State: PA
PostalCode: 152132536
CountryCode: US
TelephoneNumber: 4128028271
FaxNumber: 4126474486
Practice Location
Address1: 103 GAMMA DR
Address2: SUITE 120
City: PITTSBURGH
State: PA
PostalCode: 152382976
CountryCode: US
TelephoneNumber: 4127811917
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/05/2007
LastUpdateDate: 09/02/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000XOS014372PAY Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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