MEDICARE: JOLENE JAN SHUMAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	12145	NH
2	207Q00000X	Family Medicine Physician	MD17752	ME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407831910
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOLENE JAN SHUMAN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 412503
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02241-2503
Country	:	US
Telephone Number	:	617-726-3884
Fax Number	:	617-643-7961

Provider Business Practice Location Address
First Line	:	150 MARKETPLACE BLVD
Second Line	:
City	:	ROCHESTER
State	:	NH
Zip	:	03867-4386
Country	:	US
Telephone Number	:	603-516-4212
Fax Number	:	603-516-4213

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/08/2005
Last Update Date	:	08/23/2023

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