Provider Demographics
NPI:1730184854
Name:SHANAHAN, CHRISTOPHER W (MD, MPH)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:W
Last Name:SHANAHAN
Suffix:
Gender:M
Credentials:MD, MPH
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Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:801 ALBANY ST FL G
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02119-3791
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1575 BLUE HILL AVE
Practice Address - Street 2:
Practice Address - City:MATTAPAN
Practice Address - State:MA
Practice Address - Zip Code:02126-2122
Practice Address - Country:US
Practice Address - Phone:617-829-6006
Practice Address - Fax:617-296-5408
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA740992083A0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110050376AMedicaid
MAJ1150001Medicare PIN