1972853042 NPI number — DR. SHWETA ATUL SHINAGARE M.D.

Table of content: ABIGAIL NAKAMITSU (NPI 1932459179)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972853042 NPI number — DR. SHWETA ATUL SHINAGARE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHINAGARE
Provider First Name:
SHWETA
Provider Middle Name:
ATUL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

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:
1972853042
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/14/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
33 POND AVE
Provider Second Line Business Mailing Address:
APT B-514
Provider Business Mailing Address City Name:
BROOKLINE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02445-7163
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-901-8720
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 WASHINGTON STREET
Provider Second Line Business Practice Location Address:
BOX 836 TUFTS MEDICAL CENTER
Provider Business Practice Location Address City Name:
BOSTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02111
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-636-5196
Provider Business Practice Location Address Fax Number:
617-636-8215
Provider Enumeration Date:
09/14/2012

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: 207ZP0102X , with the licence number:  252680 , 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)





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