Provider Demographics
NPI:1952312969
Name:SHIELDS, SARA G (FAMILY PRACTICE)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:G
Last Name:SHIELDS
Suffix:
Gender:F
Credentials:FAMILY PRACTICE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 QUEEN ST
Mailing Address - Street 2:MEDICAL
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01610-2473
Mailing Address - Country:US
Mailing Address - Phone:508-860-7700
Mailing Address - Fax:508-860-7990
Practice Address - Street 1:26 QUEEN ST
Practice Address - Street 2:MEDICAL
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01610-2473
Practice Address - Country:US
Practice Address - Phone:508-860-7700
Practice Address - Fax:508-860-7990
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA78916207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA7032OtherFALLON SELECT
MA0006767OtherNHP-GROUP
MA0080097OtherEVERCARE-GROUP
MA0105221OtherEVERCARE
MA7897OtherHARVARD PILGRIM
MAJ16368OtherBCBS
MA1300709Medicaid
MA99734701OtherNETWORK HEALTH
MA2094515OtherUNITED HEALTHCARE
MA23462OtherCMSP
MA347290OtherCIGNA
MAY10141OtherBCBS-GROUP
MA0002449OtherNHP
MA1300709OtherCMSP-GROUP
MAF59801Medicare UPIN
MAA20509Medicare ID - Type UnspecifiedPART B
MAF59801Medicare Oscar/Certification
MA0002449OtherNHP
MA0080097OtherEVERCARE-GROUP