Provider Demographics
NPI:1447225834
Name:MOHIUDDIN, SHAHAB (MD)
Entity Type:Individual
Prefix:
First Name:SHAHAB
Middle Name:
Last Name:MOHIUDDIN
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 1:850 WASHINGTON ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02026-6000
Mailing Address - Country:US
Mailing Address - Phone:781-375-3805
Mailing Address - Fax:781-375-3810
Practice Address - Street 1:850 WASHINGTON ST
Practice Address - Street 2:SUITE 1
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026-6000
Practice Address - Country:US
Practice Address - Phone:781-375-3805
Practice Address - Fax:781-375-3810
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA203283207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2010585Medicaid
MAJ26211OtherBCBSMA
MA203283OtherTUFTS HEALTH PLAN
MA697799OtherHARVARD PILGRIM
MAA35278Medicare ID - Type Unspecified
MA2010585Medicaid