Provider Demographics
NPI:1366476731
Name:PARSEGHIAN, SHANT A (MD)
Entity Type:Individual
Prefix:
First Name:SHANT
Middle Name:A
Last Name:PARSEGHIAN
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 1:92 MONTVALE AVE
Mailing Address - Street 2:SUITE 3675
Mailing Address - City:STONEHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02180
Mailing Address - Country:US
Mailing Address - Phone:781-438-1800
Mailing Address - Fax:781-438-1822
Practice Address - Street 1:92MONTVALE AVE
Practice Address - Street 2:SUITE 3675
Practice Address - City:STONEHAM
Practice Address - State:MA
Practice Address - Zip Code:02180
Practice Address - Country:US
Practice Address - Phone:781-438-1800
Practice Address - Fax:781-438-1822
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA239269207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00358375OtherRAILROAD MEDICARE
250766OtherHEALTH LINK
MO308311308Medicaid
I62086OtherPREMIER PLUS
215199OtherBCBS
I62086OtherPREMIER PLUS