Provider Demographics
NPI:1700052388
Name:SHAH, BHUMI (MD)
Entity Type:Individual
Prefix:
First Name:BHUMI
Middle Name:
Last Name:SHAH
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 1:267 BOSTON RD
Mailing Address - Street 2:LAHEY
Mailing Address - City:NORTH BILLERICA
Mailing Address - State:MA
Mailing Address - Zip Code:01862-2310
Mailing Address - Country:US
Mailing Address - Phone:978-663-6666
Mailing Address - Fax:
Practice Address - Street 1:267 BOSTON RD
Practice Address - Street 2:LAHEY
Practice Address - City:NORTH BILLERICA
Practice Address - State:MA
Practice Address - Zip Code:01862-2310
Practice Address - Country:US
Practice Address - Phone:978-663-6666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-05
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA243542207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110086596AMedicaid
MA110086596AMedicaid