Provider Demographics
NPI:1962483222
Name:SHAPIRO, JONATHAN M (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:M
Last Name:SHAPIRO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1 COMPASS WAY STE 105
Mailing Address - Street 2:
Mailing Address - City:EAST BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02333-1464
Mailing Address - Country:US
Mailing Address - Phone:508-350-2220
Mailing Address - Fax:508-350-2312
Practice Address - Street 1:1 COMPASS WAY STE 105
Practice Address - Street 2:
Practice Address - City:EAST BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02333
Practice Address - Country:US
Practice Address - Phone:508-350-2220
Practice Address - Fax:508-350-2312
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA768132085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA076813OtherTUFTS HEALTH PLAN
MA300134671OtherRAILROAD MEDICARE
MA410429OtherBLUE CHIP RI
MAJ03611OtherBCBS MA
MA04-3140277OtherGREAT WEST HEALTHCARE
MA04-3140277OtherHCVM FIRST HEALTH
MA04-3140277OtherTRICARE
MA3110311Medicaid
MA000000028369OtherHEALTH NET
MA0866567003OtherCIGNA NH
MA16-00012OtherUNITED HEALTHCARE RI
MA244996OtherHARVARD PILGRIM
MAP00608947OtherRR MEDICARE
MA4700OtherBCBS RI
MAJ03611OtherBLUE CARE ELECT
MA04-3140277OtherGREAT WEST HEALTHCARE
MAA31215Medicare PIN