Provider Demographics
NPI:1649258724
Name:AMERI, SHAPUR ALI MOGHTADER (MD)
Entity type:Individual
Prefix:DR
First Name:SHAPUR
Middle Name:ALI MOGHTADER
Last Name:AMERI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 1789
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01701-1789
Mailing Address - Country:US
Mailing Address - Phone:508-879-5040
Mailing Address - Fax:508-875-7849
Practice Address - Street 1:61 LINCOLN ST
Practice Address - Street 2:SUITE 108
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-8264
Practice Address - Country:US
Practice Address - Phone:508-879-5040
Practice Address - Fax:508-875-7849
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA51413207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6195431Medicaid
MA6195431Medicaid
MAA57208Medicare UPIN