1780747832 NPI number — NARENDRA K SHAH MD

Table of content: NARENDRA K SHAH MD (NPI 1780747832)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780747832 NPI number — NARENDRA K SHAH MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHAH
Provider First Name:
NARENDRA
Provider Middle Name:
K
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:
1780747832
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/03/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6 STONEHILL CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BURLINGTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01803-1425
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-710-4701
Provider Business Mailing Address Fax Number:
781-365-0302

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 CAMBRIDGE ST STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BURLINGTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01803-3767
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-718-7716
Provider Business Practice Location Address Fax Number:
781-365-0302
Provider Enumeration Date:
12/19/2006

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: 207L00000X , with the licence number:  34550 , 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: 2019094 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 123528 . This is a "US HEALTHCARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 700449 . This is a "TUFTS AND SECURE HORIZONS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: MO8681 . This is a "HMO BLUE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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