Provider Demographics
NPI:1891166187
Name:SHAWSHEEN ANIMAL HOSPITAL
Entity Type:Organization
Organization Name:SHAWSHEEN ANIMAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VETERINARIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:FAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DVM
Authorized Official - Phone:978-851-5558
Mailing Address - Street 1:1415 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TEWKSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01876-2041
Mailing Address - Country:US
Mailing Address - Phone:978-851-5558
Mailing Address - Fax:978-851-2597
Practice Address - Street 1:1415 MAIN ST
Practice Address - Street 2:
Practice Address - City:TEWKSBURY
Practice Address - State:MA
Practice Address - Zip Code:01876-2041
Practice Address - Country:US
Practice Address - Phone:978-851-5558
Practice Address - Fax:978-851-2597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-12
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7332174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174M00000XOther Service ProvidersVeterinarianGroup - Single Specialty