Provider Demographics
NPI:1063479798
Name:BERKOWITZ, SHAWN ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:ANTHONY
Last Name:BERKOWITZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:SHAWN
Other - Middle Name:ANTHONY
Other - Last Name:BERKOWITZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:10 RESEARCH PL STE 200
Mailing Address - Street 2:
Mailing Address - City:NORTH CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01863-2439
Mailing Address - Country:US
Mailing Address - Phone:978-323-7085
Mailing Address - Fax:978-630-5792
Practice Address - Street 1:10 RESEARCH PL STE 200
Practice Address - Street 2:
Practice Address - City:NORTH CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01863-2439
Practice Address - Country:US
Practice Address - Phone:978-323-7085
Practice Address - Fax:978-630-5792
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA257826207QG0300X
NY237935207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
06158729OtherECFMG #
NY02700838Medicaid
06158729OtherECFMG #
NY02700838Medicaid