Provider Demographics
NPI:1457344574
Name:MASHIKIAN, JOHN (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:MASHIKIAN
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 1:690 CANTON ST
Mailing Address - Street 2:SUITE 325
Mailing Address - City:WESTWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02090-2321
Mailing Address - Country:US
Mailing Address - Phone:781-407-7713
Mailing Address - Fax:781-407-0998
Practice Address - Street 1:680 CENTRE ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02302-3308
Practice Address - Country:US
Practice Address - Phone:401-490-2130
Practice Address - Fax:401-435-2483
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD11923207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AA115299OtherHPHC
MAJ31081OtherBCBS
MA39845OtherFALLON
510492088OtherUHC
39845OtherFALLON
MAAA117151OtherHPHC
MA1457344574OtherSENIOR WHOLE HEALTH
MA1457344574OtherBMC
MA3134831Medicaid
J31081OtherBCBS
MA3134831Medicaid
J31081OtherBCBS
MA1457344574OtherBMC
J3108102Medicare PIN