Provider Demographics
NPI:1871521096
Name:O'SHEA, KATHERINE A (MD)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:A
Last Name:O'SHEA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9318 STATE ROUTE 14
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:STREETSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:44241
Mailing Address - Country:US
Mailing Address - Phone:330-626-3455
Mailing Address - Fax:330-626-4189
Practice Address - Street 1:9318 STATE ROUTE 14
Practice Address - Street 2:1ST FLOOR
Practice Address - City:STREETSBORO
Practice Address - State:OH
Practice Address - Zip Code:44241
Practice Address - Country:US
Practice Address - Phone:330-626-3455
Practice Address - Fax:330-626-4189
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-06-6658-0207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0104292Medicaid
OHF93912Medicare UPIN
OHOS0774265Medicare ID - Type Unspecified