Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 233439 | MA |
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 251049 | MA |
NPI | 1164611687 |
---|---|
Provider Name | Dr. Vivek Manhar Shah |
First Address | Brookline, MA 02445-6007 |
Second Address | Boston, MA 02111 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/10/2007 |
Last Update Date | 29/08/2018 |