Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Shannon Petukhov, MD

Individual provider Emergency Medicine Physician · NPI 1427402627

Shannon Petukhov, MD is an Emergency Medicine in Annapolis, Maryland. Graduated from University of Maryland School of Medicine in 2015, 11 years ago. Practices with Kaiser Foundation Health Plan of the Mid Atlantic States, Inc, a 1,934-clinician group and accepts Medicare assignment. Licensed in Maryland.

Years since qualifying
11
Trained at
University of Maryland School of Medicine
Licensed in
MD
In the registry since
2016
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

2001 Medical Pkwy
Annapolis, MD 21401-3773
Phone: (443) 481-1366
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Emergency Medicine Physician (primary) Taxonomy 207P00000X · Licence D0087812 (MD)

Record details

NPI number1427402627
Entity typeIndividual (Type 1)
GenderFemale
Credentials MD
Sole proprietorYes
NPI enumeratedApril 14, 2016
Last updated in NPPESFebruary 6, 2020
Certification dateFebruary 6, 2020

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyEMERGENCY MEDICINE
Medical schoolUNIVERSITY OF MARYLAND SCHOOL OF MEDICINE
Graduated 2015 (11 years in practice)
Group practice Kaiser Foundation Health Plan Of The Mid Atlantic States, Inc — 1934 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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