Provider Demographics
NPI:1457348948
Name:SHEN, ALICE IL (MD)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:IL
Last Name:SHEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:315 NORWOOD PARK SOUTH
Mailing Address - Street 2:STE 201
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062
Mailing Address - Country:US
Mailing Address - Phone:781-414-4150
Mailing Address - Fax:781-414-4151
Practice Address - Street 1:315 NORWOOD PARK SOUTH
Practice Address - Street 2:STE. 201
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-3466
Practice Address - Country:US
Practice Address - Phone:781-414-4150
Practice Address - Fax:781-414-4151
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA220573207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2070219Medicaid
MAA37173Medicare ID - Type Unspecified
I10307Medicare UPIN