Provider Demographics
NPI:1619915717
Name:SHOTKIN, ALAN M (MD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:M
Last Name:SHOTKIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 MOUNT AUBURN STREET
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-5502
Mailing Address - Country:US
Mailing Address - Phone:617-499-5540
Mailing Address - Fax:617-499-5699
Practice Address - Street 1:330 MOUNT AUBURN ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-5502
Practice Address - Country:US
Practice Address - Phone:617-499-5540
Practice Address - Fax:617-499-5699
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2813692080N0001X
CAG706752080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G706750Medicaid
CA00G706750Medicare PIN
CA00G706750Medicaid