Provider Demographics
NPI:1881764017
Name:SHAFIQUE, TAJAMMUL (MD)
Entity type:Individual
Prefix:
First Name:TAJAMMUL
Middle Name:
Last Name:SHAFIQUE
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:PO BOX 1328
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04211-1328
Mailing Address - Country:US
Mailing Address - Phone:207-784-9185
Mailing Address - Fax:207-784-1594
Practice Address - Street 1:25 COUNTRY CLUB RD
Practice Address - Street 2:VILLAGE WEST, BUILDING 7
Practice Address - City:GILFORD
Practice Address - State:NH
Practice Address - Zip Code:03249-6972
Practice Address - Country:US
Practice Address - Phone:603-528-1547
Practice Address - Fax:603-524-5536
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH9747208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30009821Medicaid
NHG29607Medicare UPIN
NH30009821Medicaid
NHRE4169Medicare ID - Type Unspecified