Provider Demographics
NPI:1083704860
Name:ABBOUD, SHADI ADIB (DPM)
Entity Type:Individual
Prefix:DR
First Name:SHADI
Middle Name:ADIB
Last Name:ABBOUD
Suffix:
Gender:M
Credentials:DPM
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Mailing Address - Street 1:100 CROSSING BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-5555
Mailing Address - Country:US
Mailing Address - Phone:617-964-6681
Mailing Address - Fax:339-686-2561
Practice Address - Street 1:100CROSSING BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-5555
Practice Address - Country:US
Practice Address - Phone:617-964-6681
Practice Address - Fax:339-686-2561
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2020-01-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA2300213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY7515801Medicare PIN