Provider Demographics
NPI:1780680488
Name:SHUSTERMAN, MICHAEL S (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:S
Last Name:SHUSTERMAN
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 1:1 LYONS ST
Mailing Address - Street 2:
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02026-5599
Mailing Address - Country:US
Mailing Address - Phone:781-493-3620
Mailing Address - Fax:781-461-9210
Practice Address - Street 1:1 LYONS ST
Practice Address - Street 2:
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026-5599
Practice Address - Country:US
Practice Address - Phone:781-493-3620
Practice Address - Fax:781-461-9210
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2021-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA160164208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
160164OtherTUFTS COMMONWEALTH PRO
160164OtherTUFTS BENEFIT ADMIN
160164OtherTUFTS TOTAL HEALTH PLAN
MH1549OtherFIRST SENIORITY
1545423OtherCIGNA HEALTH CARE
160164OtherTUFTS
A29870OtherMEDICARE
J21503OtherHMO BLUE/BLUE CHOICE
202046OtherHARVARD PILGRIM POS
27712OtherCHILDREN'S MEDICAL SECURI
0018167OtherNEIGHBORHOOD HEALTH PLAN
1240697OtherUNITED HEALTHCARE(PPO)
MA1545423OtherHEALTHSOURCE
202046OtherHARVARD PILGRIM PPO
3194647OtherMASS HEALTH
J21503OtherBLUE SHIELD-INDEMNITY
202046OtherHARVARD/PILGRIM
J21503OtherBS-BLUE CARE ELECT
A29870OtherMEDICARE