Provider Demographics
NPI:1992027213
Name:SHORE, BENJAMIN JOEL (MD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:JOEL
Last Name:SHORE
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 1:300 LONGWOOD AVE
Mailing Address - Street 2:DEPARTMENT OF ORTHOPEDIC SURGERY - HUNNEWELL 221
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-5724
Mailing Address - Country:US
Mailing Address - Phone:617-355-6808
Mailing Address - Fax:617-730-0465
Practice Address - Street 1:300 LONGWOOD AVE
Practice Address - Street 2:DEPARTMENT OF ORTHOPEDIC SURGERY - HUNNEWELL 221
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5724
Practice Address - Country:US
Practice Address - Phone:617-355-6808
Practice Address - Fax:617-730-0465
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-01
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD24223207X00000X
MA243828207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA239359OtherCERTIFICATE OF LIMITED REGISTRATION
MA243828OtherMASS LICENCE