Provider Demographics
NPI:1265408462
Name:SHEA, WILLIAM D (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:D
Last Name:SHEA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:830 BOYLSTON ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467-2503
Mailing Address - Country:US
Mailing Address - Phone:617-277-1205
Mailing Address - Fax:617-232-6528
Practice Address - Street 1:830 BOYLSTON ST
Practice Address - Street 2:SUITE 106
Practice Address - City:CHESTNUT HILL
Practice Address - State:MA
Practice Address - Zip Code:02467-2503
Practice Address - Country:US
Practice Address - Phone:617-277-1205
Practice Address - Fax:617-232-6528
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2012-07-18
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Provider Licenses
StateLicense IDTaxonomies
MA32684207XX0005X, 207X00000X, 207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2504746OtherAETNA
MA26525OtherFALLON COMM HEALTH PLAN
MA032384OtherTUFTS HEALTH PLAN
MA0101931Medicaid
MA17755OtherHARVARD PILGRIM
MAM07902OtherBLUE CROSS BLUE SHIELD
MA17755OtherHARVARD PILGRIM
MA032384OtherTUFTS HEALTH PLAN
MADX3413Medicare PIN