Provider Demographics
NPI:1376523035
Name:SHOYER, JAN R (MD)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:R
Last Name:SHOYER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 HOLLAND ST
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02144-2705
Mailing Address - Country:US
Mailing Address - Phone:617-629-6300
Mailing Address - Fax:617-629-6090
Practice Address - Street 1:40 HOLLAND ST
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02144-2705
Practice Address - Country:US
Practice Address - Phone:617-629-6300
Practice Address - Fax:617-629-6090
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA73160208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ16087OtherBLUE CROSS
MA073160OtherTUFTS
MA0015153OtherNEIGHBORHOOD HEALTH
MAPP412OtherHARVARD PILGRIM
MA3202593Medicaid
MAA20397Medicare ID - Type Unspecified
MAJ16087OtherBLUE CROSS