Provider Demographics
NPI:1649233495
Name:KRAMER, SHELLEY D (MD)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:D
Last Name:KRAMER
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 1:33 LYMAN ST
Mailing Address - Street 2:
Mailing Address - City:WESTBORO
Mailing Address - State:MA
Mailing Address - Zip Code:01581
Mailing Address - Country:US
Mailing Address - Phone:508-366-1550
Mailing Address - Fax:508-836-9518
Practice Address - Street 1:33 LYMAN ST
Practice Address - Street 2:STE 101A B
Practice Address - City:WESTBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01581
Practice Address - Country:US
Practice Address - Phone:508-366-1550
Practice Address - Fax:508-836-9518
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA57223207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3028020Medicaid
B97997Medicare UPIN
KRJ06219Medicare ID - Type Unspecified