Provider Demographics
NPI:1407831910
Name:SHUMAN, JOLENE JAN (MD)
Entity Type:Individual
Prefix:
First Name:JOLENE
Middle Name:JAN
Last Name:SHUMAN
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:PO BOX 412503
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-2503
Mailing Address - Country:US
Mailing Address - Phone:617-726-3884
Mailing Address - Fax:617-643-7961
Practice Address - Street 1:150 MARKETPLACE BLVD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03867-4386
Practice Address - Country:US
Practice Address - Phone:603-516-4212
Practice Address - Fax:603-516-4213
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH12145207Q00000X
MEMD17752207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3073988Medicaid
NHRE753802Medicare UPIN