Provider Demographics
NPI:1710980230
Name:SHOKRI, JAHANSOUZ (MD)
Entity Type:Individual
Prefix:DR
First Name:JAHANSOUZ
Middle Name:
Last Name:SHOKRI
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 1:485 ARSENAL ST
Mailing Address - Street 2:INTERNAL MEDICINE
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-5091
Mailing Address - Country:US
Mailing Address - Phone:617-972-5240
Mailing Address - Fax:617-972-5512
Practice Address - Street 1:485 ARSENAL ST
Practice Address - Street 2:INTERNAL MEDICINE
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-5091
Practice Address - Country:US
Practice Address - Phone:617-972-5240
Practice Address - Fax:617-972-5512
Is Sole Proprietor?:No
Enumeration Date:2005-05-30
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004027804207RC0200X
MA230266207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA000073801Medicaid
MO208325209Medicaid
MA000073801Medicaid
MA2132729Medicare PIN