Provider Demographics
NPI:1609802180
Name:RAMCHANDANI, SHIRLY HASHUMAL (MD)
Entity Type:Individual
Prefix:
First Name:SHIRLY
Middle Name:HASHUMAL
Last Name:RAMCHANDANI
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 1:147 MILK ST
Mailing Address - Street 2:PROVIDER ENROLLMENT - 9TH FLOOR
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02109-4806
Mailing Address - Country:US
Mailing Address - Phone:617-559-8374
Mailing Address - Fax:
Practice Address - Street 1:11 NEVINS ST STE 304
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-3514
Practice Address - Country:US
Practice Address - Phone:857-242-0070
Practice Address - Fax:617-562-0600
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA156897207RB0002X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RB0002XAllopathic & Osteopathic PhysiciansInternal MedicineObesity Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0018929OtherNEIGHBORHOOD HEALTH
MAJ18931OtherBLUE CROSS
MA156897OtherTUFTS
MAV933OtherHARVRD PILGRIM
MA3178749Medicaid
MAG72166Medicare UPIN
MAA28473Medicare PIN