Provider Demographics
NPI:1073616348
Name:MASHIMO, HIROSHI (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:HIROSHI
Middle Name:
Last Name:MASHIMO
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 VFW PKWY
Mailing Address - Street 2:RES 151 BLD 3
Mailing Address - City:W ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02132
Mailing Address - Country:US
Mailing Address - Phone:857-203-5640
Mailing Address - Fax:857-203-5666
Practice Address - Street 1:1400 VFW PKWY
Practice Address - Street 2:RES 151 BLD 3
Practice Address - City:W ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02132
Practice Address - Country:US
Practice Address - Phone:857-203-5640
Practice Address - Fax:857-203-5666
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA73215207RG0100X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA#3139492Medicaid
#3139492Medicare ID - Type Unspecified
MA#3139492Medicaid