Provider Demographics
NPI:1245229392
Name:LOCKMAN, SHELDON S (MD)
Entity Type:Individual
Prefix:DR
First Name:SHELDON
Middle Name:S
Last Name:LOCKMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-5526
Mailing Address - Country:US
Mailing Address - Phone:508-655-6058
Mailing Address - Fax:
Practice Address - Street 1:2100 DORCHESTER AVE
Practice Address - Street 2:
Practice Address - City:DORCHESTER CENTER
Practice Address - State:MA
Practice Address - Zip Code:02124-5615
Practice Address - Country:US
Practice Address - Phone:617-296-4000
Practice Address - Fax:617-296-7494
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA52386207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
J04686OtherBLUE CROSS/BLUE SHIELD
MA3012875Medicaid
MAJ04686Medicare ID - Type Unspecified
MAA57981Medicare UPIN