Provider Demographics
NPI:1336235324
Name:SHIELDS, STEVEN J (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:J
Last Name:SHIELDS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:133 BROOKLINE AVE
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-3904
Mailing Address - Country:US
Mailing Address - Phone:617-421-1091
Mailing Address - Fax:617-421-2555
Practice Address - Street 1:133 BROOKLINE AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-3904
Practice Address - Country:US
Practice Address - Phone:617-421-1091
Practice Address - Fax:617-421-2555
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2021-02-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA60021207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0003077OtherNEIGHBORHOOD HEALTH PLAN
MA3044203Medicaid
MA8758456-003OtherCIGNA
MAP00074997OtherMEDICARE RAILROAD
MAV020OtherHARVARD PILGRIM
MA766330OtherTUFTS HEALTH PLAN
MAJ08205OtherBLUE CROSS
MA8758456-003OtherCIGNA
MASX0861Medicare PIN