Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 258805 | MA |
NPI | 1013180553 |
---|---|
Provider Name | Dr. Samir Kaushik Shah |
First Address | Boston, MA 02115-6110 |
Second Address | Boston, MA 02115-6110 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2008 |
Last Update Date | 26/08/2016 |