MEDICARE: PETER SHAMAMIAN 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	208600000X	Surgery Physician	182562	NY

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	:	1831183656
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER SHAMAMIAN M.D.

Provider Business Mailing Address
First Line	:	3400 BAINBRIDGE AVE
Second Line	:	4TH FLOOR
City	:	BRONX
State	:	NY
Zip	:	10467-2404
Country	:	US
Telephone Number	:	718-920-4089
Fax Number	:	718-798-1833

Provider Business Practice Location Address
First Line	:	3400 BAINBRIDGE AVE
Second Line	:	4TH FLOOR
City	:	BRONX
State	:	NY
Zip	:	10467-2404
Country	:	US
Telephone Number	:	718-920-4089
Fax Number	:	718-798-1833

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

Provider Enumeration Date	:	09/08/2005
Last Update Date	:	01/03/2012

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Directions to “ PETER SHAMAMIAN M.D.” Practice Location

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