Provider Demographics
NPI:1962468710
Name:BIRNBAUM, SHANA L (MD)
Entity Type:Individual
Prefix:DR
First Name:SHANA
Middle Name:L
Last Name:BIRNBAUM
Suffix:
Gender:F
Credentials:MD
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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:617-724-2700
Mailing Address - Fax:617-726-6861
Practice Address - Street 1:15 PARKMAN STREET WAC 645
Practice Address - Street 2:INTERNAL MEDICINE ASSOCIATES TEAM 3
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-3117
Practice Address - Country:US
Practice Address - Phone:617-724-2700
Practice Address - Fax:617-726-6861
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2012-07-30
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Provider Licenses
StateLicense IDTaxonomies
MA213980207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0173266Medicaid
MA213980OtherTUFTS HEALTH PLAN
MAJ24764OtherBCBS MA
H59972Medicare UPIN
MAA33884Medicare ID - Type Unspecified