Provider Demographics
NPI:1669454609
Name:SHIFREN, JAN LESLIE (MD)
Entity Type:Individual
Prefix:DR
First Name:JAN
Middle Name:LESLIE
Last Name:SHIFREN
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Gender:F
Credentials:MD
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Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-726-8868
Mailing Address - Fax:617-724-8882
Practice Address - Street 1:55 FRUIT STREET YAW 10
Practice Address - Street 2:VINCENT OBGYN REPRODUCTIVE MED IVF
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114
Practice Address - Country:US
Practice Address - Phone:617-726-8868
Practice Address - Fax:617-726-4803
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2012-09-10
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Provider Licenses
StateLicense IDTaxonomies
MA151048207V00000X, 207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA151048OtherTUFTS HEALTH PLAN
MA3155684Medicaid
MAJ16855OtherBCBS MA
MA3155684Medicaid
F53232Medicare UPIN