Provider Demographics
NPI:1518983071
Name:LATIF, SHAZIA (MD)
Entity Type:Individual
Prefix:
First Name:SHAZIA
Middle Name:
Last Name:LATIF
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 1:303 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02703-1752
Mailing Address - Country:US
Mailing Address - Phone:508-222-2086
Mailing Address - Fax:508-226-8552
Practice Address - Street 1:303 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-1752
Practice Address - Country:US
Practice Address - Phone:508-222-2086
Practice Address - Fax:508-226-8552
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA227247208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3712680OtherCIGNA
MAAA58944OtherHPHC
MA115405OtherFALLON
MA2119374Medicaid
MA494679OtherTUFTS
MA000000033280OtherBMC HEALTHNET
RI413295OtherRIBCHIP
MAJ40011OtherMABC
MA494679OtherTUFTS