Provider Demographics
NPI:1811952955
Name:SHAMIR, KENATH J (MD)
Entity type:Individual
Prefix:DR
First Name:KENATH
Middle Name:J
Last Name:SHAMIR
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:200 MILL RD
Mailing Address - Street 2:STE 180
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-5252
Mailing Address - Country:US
Mailing Address - Phone:508-973-2000
Mailing Address - Fax:508-973-2001
Practice Address - Street 1:1030 PRESIDENT AVE
Practice Address - Street 2:SUITE 1001
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-5923
Practice Address - Country:US
Practice Address - Phone:508-973-9650
Practice Address - Fax:508-973-9655
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2020-04-27
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Provider Licenses
StateLicense IDTaxonomies
MA73594207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA10048493AMedicaid
MAJ1008502Medicare PIN
MA110219113OtherRAILROAD MEDICARE
MAJ10085OtherBLUE SHIELD
MAJ10085Medicare ID - Type UnspecifiedMEDICARE
MA000000021251OtherBMC HEALTHNET
MA0016211OtherNEIGHBORHOOD HEALTH PLAN
MA0403473OtherUNITED HEALTHCARE
MA073594OtherTUFTS
RI004233OtherBLUE CHIP
RI0000029259OtherBLUE SHIELD
MA6929OtherHARVARD PILGRIM
MAB10188703OtherCIGNA
MA3684745OtherHEALTHSOURCE
MA3063658Medicaid