Provider Demographics
NPI:1427014935
Name:SHANA, CHARLES B (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:B
Last Name:SHANA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:200 MILL RD
Mailing Address - Street 2:STE 180
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-5252
Mailing Address - Country:US
Mailing Address - Phone:508-973-2000
Mailing Address - Fax:508-973-2001
Practice Address - Street 1:1030 PRESIDENT AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-5923
Practice Address - Country:US
Practice Address - Phone:508-235-6349
Practice Address - Fax:508-973-1715
Is Sole Proprietor?:No
Enumeration Date:2006-04-24
Last Update Date:2020-04-27
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Provider Licenses
StateLicense IDTaxonomies
RIMD06300207RG0100X
MA54052207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3048756Medicaid
MA6654OtherHARVARD PILGRIM
MA000000021258OtherBMC HEALTHNET
MAJ08749OtherBC BS OF MA
RI0000025599OtherBC BS OF RI
RI201678OtherBLUECHIP
RI201678OtherBLUECHIP
MAE15383Medicare UPIN