Provider Demographics
NPI:1689611386
Name:SHAKESPEARE, BETINA D (MD)
Entity Type:Individual
Prefix:
First Name:BETINA
Middle Name:D
Last Name:SHAKESPEARE
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 1:2 HUBLEY LN
Mailing Address - Street 2:
Mailing Address - City:SOUTHBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01772-1991
Mailing Address - Country:US
Mailing Address - Phone:508-460-3250
Mailing Address - Fax:
Practice Address - Street 1:24 NEWTON STREET
Practice Address - Street 2:SOUTHBOROUGH MEDICAL GROUP
Practice Address - City:SOUTHBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01772
Practice Address - Country:US
Practice Address - Phone:508-460-3250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA159089207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine