Provider Demographics
NPI:1982799854
Name:SHAKUR, UMAR MUHAMMAD (DO)
Entity Type:Individual
Prefix:DR
First Name:UMAR
Middle Name:MUHAMMAD
Last Name:SHAKUR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 DORCHESTER AVE
Mailing Address - Street 2:DEPARTMENT OF CARDIOLOGY
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02124-5615
Mailing Address - Country:US
Mailing Address - Phone:617-296-4000
Mailing Address - Fax:617-474-3860
Practice Address - Street 1:2 HAYWARD ST
Practice Address - Street 2:
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-2113
Practice Address - Country:US
Practice Address - Phone:508-431-3600
Practice Address - Fax:508-431-2545
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA258854207R00000X, 207RC0000X
RIDO00662207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110087905AMedicaid
RIUS82064Medicaid