Provider Demographics
NPI:1780747832
Name:SHAH, NARENDRA K (MD)
Entity type:Individual
Prefix:
First Name:NARENDRA
Middle Name:K
Last Name:SHAH
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 1:6 STONEHILL CIR
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01803-1425
Mailing Address - Country:US
Mailing Address - Phone:781-710-4701
Mailing Address - Fax:781-365-0302
Practice Address - Street 1:101 CAMBRIDGE ST STE 100
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-3767
Practice Address - Country:US
Practice Address - Phone:781-718-7716
Practice Address - Fax:781-365-0302
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA34550207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2019094Medicaid
MA123528OtherUS HEALTHCARE
MA700449OtherTUFTS AND SECURE HORIZONS
MAMO8681OtherHMO BLUE
MAM08681Medicare ID - Type Unspecified
MA2019094Medicaid