Provider Demographics
NPI:1811962327
Name:SHAH, SHIMUL A (MD)
Entity type:Individual
Prefix:
First Name:SHIMUL
Middle Name:A
Last Name:SHAH
Suffix:
Gender:
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:960 MASSACHUSETTS AVENUE
Mailing Address - Street 2:FL 2
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2690
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:725 ALBANY STREET, SUITE 7A
Practice Address - Street 2:SHAPIRO BLDG.
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118
Practice Address - Country:US
Practice Address - Phone:617-638-8430
Practice Address - Fax:617-638-8427
Is Sole Proprietor?:No
Enumeration Date:2006-02-18
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35.099739204F00000X
MA159960204F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3148308Medicaid
MA110062557AMedicaid
MA3208133Medicaid