1780680488 NPI number — MICHAEL S SHUSTERMAN MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780680488 NPI number — MICHAEL S SHUSTERMAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHUSTERMAN
Provider First Name:
MICHAEL
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780680488
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 LYONS ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DEDHAM
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02026-5599
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-493-3620
Provider Business Mailing Address Fax Number:
781-461-9210

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 LYONS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DEDHAM
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02026-5599
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-493-3620
Provider Business Practice Location Address Fax Number:
781-461-9210
Provider Enumeration Date:
06/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  160164 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 160164 . This is a "TUFTS COMMONWEALTH PRO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 160164 . This is a "TUFTS BENEFIT ADMIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 160164 . This is a "TUFTS TOTAL HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: MH1549 . This is a "FIRST SENIORITY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1545423 . This is a "CIGNA HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 160164 . This is a "TUFTS" identifier . This identifiers is of the category "OTHER".
  • Identifier: A29870 . This is a "MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: J21503 . This is a "HMO BLUE/BLUE CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 202046 . This is a "HARVARD PILGRIM POS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 27712 . This is a "CHILDREN'S MEDICAL SECURI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0018167 . This is a "NEIGHBORHOOD HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1240697 . This is a "UNITED HEALTHCARE(PPO)" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1545423 . This is a "HEALTHSOURCE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 202046 . This is a "HARVARD PILGRIM PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3194647 . This is a "MASS HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: J21503 . This is a "BLUE SHIELD-INDEMNITY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 202046 . This is a "HARVARD/PILGRIM" identifier . This identifiers is of the category "OTHER".
  • Identifier: J21503 . This is a "BS-BLUE CARE ELECT" identifier . This identifiers is of the category "OTHER".




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