Provider Demographics
NPI:1609101732
Name:SEHRA, SHIV TEJ (MD)
Entity Type:Individual
Prefix:
First Name:SHIV
Middle Name:TEJ
Last Name:SEHRA
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 1:725 CONCORD AVE
Mailing Address - Street 2:SUITE 2000, RESERVOIR MEDICAL ASSOCIATES
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-1040
Mailing Address - Country:US
Mailing Address - Phone:617-661-4600
Mailing Address - Fax:
Practice Address - Street 1:725 CONCORD AVE
Practice Address - Street 2:SUITE 2000, RESERVOIR MEDICAL ASSOCIATES
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-1040
Practice Address - Country:US
Practice Address - Phone:617-661-4600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-07
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA257954207RR0500X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine