Provider Demographics
NPI:1477530418
Name:NESATHURAI, SHANKER (MD)
Entity Type:Individual
Prefix:
First Name:SHANKER
Middle Name:
Last Name:NESATHURAI
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:PO BOX 9142
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-0287
Mailing Address - Fax:617-726-2894
Practice Address - Street 1:125 NASHUA ST SRH
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-1198
Practice Address - Country:US
Practice Address - Phone:617-573-2200
Practice Address - Fax:617-573-2209
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA78719208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ31222OtherBCBS MA
MA756152OtherTUFTS HEALTH PLAN
MA3139719Medicaid
MA756152OtherTUFTS HEALTH PLAN
MAJ31222OtherBCBS MA