Provider Demographics
NPI:1518056035
Name:DRS. SHOCAIR AND REDA, P.C.
Entity Type:Organization
Organization Name:DRS. SHOCAIR AND REDA, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAWYA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHOCAIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-899-5555
Mailing Address - Street 1:6 LEXINGTON ST
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02452-4401
Mailing Address - Country:US
Mailing Address - Phone:781-899-5555
Mailing Address - Fax:781-899-0300
Practice Address - Street 1:6 LEXINGTON ST
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02452-4401
Practice Address - Country:US
Practice Address - Phone:781-899-5555
Practice Address - Fax:781-899-0300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Not Answered207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9715096Medicaid
M12739Medicare ID - Type Unspecified