Provider Demographics
NPI:1881751204
Name:JHA, SHIVKUMAR H (MD)
Entity type:Individual
Prefix:
First Name:SHIVKUMAR
Middle Name:H
Last Name:JHA
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 1:23 WYMAN RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02420-3237
Mailing Address - Country:US
Mailing Address - Phone:617-817-6041
Mailing Address - Fax:
Practice Address - Street 1:23 WYMAN RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-3237
Practice Address - Country:US
Practice Address - Phone:617-817-6041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2306402084P0800X, 2084P0805X
TXN85232084P0800X, 2084P0805X
NMMD2012-08642084P0805X
KS04-431442084P0805X
DCMD0440422084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry