Provider Demographics
NPI:1639117120
Name:SHAUKAT, KHAYAM (MD)
Entity Type:Individual
Prefix:DR
First Name:KHAYAM
Middle Name:
Last Name:SHAUKAT
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 1:291 INDEPENDENCE DR
Mailing Address - Street 2:INTERNAL MEDICINE
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467-3628
Mailing Address - Country:US
Mailing Address - Phone:617-541-6505
Mailing Address - Fax:671-541-6444
Practice Address - Street 1:291 INDEPENDENCE DR
Practice Address - Street 2:INTERNAL MEDICINE
Practice Address - City:CHESTNUT HILL
Practice Address - State:MA
Practice Address - Zip Code:02467-3628
Practice Address - Country:US
Practice Address - Phone:617-541-6505
Practice Address - Fax:617-541-6444
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2017-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME101820207R00000X, 208M00000X
OH350582718S207R00000X
MA226708207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2158205Medicaid
OH2438393Medicaid
OH2438393Medicaid
MA2158205Medicaid
OHH94060Medicare UPIN