Provider Demographics
NPI:1760473292
Name:TABATABAEI, SHAHIN (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAHIN
Middle Name:
Last Name:TABATABAEI
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: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:617-726-3574
Mailing Address - Fax:617-726-6131
Practice Address - Street 1:15 PARKMAN ST
Practice Address - Street 2:DEPT OF UROLOGY MGH
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-3117
Practice Address - Country:US
Practice Address - Phone:617-726-3010
Practice Address - Fax:617-726-6131
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA209109208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0188760Medicaid
MAJ25678OtherBCBS MA
MA209109OtherTUFTS HEALTH PLAN
MA209109OtherTUFTS HEALTH PLAN
MAJ25678OtherBCBS MA