NPI 1477057883 · live from the CMS NPI Registry
Shannon Altazan, DO
Emergency Medicine in Marietta, OH. National Provider Identifier 1477057883, active.
NPI record
| NPI | 1477057883 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Emergency Medicine 207P00000X |
| Practice location | 401 Matthew St, Marietta, OH 45750 |
| Practice phone | 740-376-1939 |
| Mailing address | 1467 Tornes Rd, Lowell, OH 45744 |
| Enumerated | March 20, 2018 |
| Last updated | February 19, 2026 |
| Sole proprietor | Yes |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Emergency Medicine primary | 207P00000X | 34.015793 (OH) |
| Emergency Medicine | 207P00000X | 3742 (WV) |
| Family Medicine | 207Q00000X | 34.015793 (OH) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.