Provider Demographics
NPI:1902595705
Name:ALICE M SHIN, MD, PLLC
Entity Type:Organization
Organization Name:ALICE M SHIN, MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-209-9606
Mailing Address - Street 1:1180 BEACON ST STE A
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-3870
Mailing Address - Country:US
Mailing Address - Phone:617-209-9606
Mailing Address - Fax:617-232-2055
Practice Address - Street 1:1180 BEACON ST STE A
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-3870
Practice Address - Country:US
Practice Address - Phone:617-209-9606
Practice Address - Fax:617-232-2055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-05
Last Update Date:2023-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty