Healthcare Provider Details

I. General information

NPI: 1619662541
Provider Name (Legal Business Name): TAHA SHAKARCHI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2023
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 HIGHLAND AVE
SALEM MA
01970-2768
US

IV. Provider business mailing address

399 REVOLUTION DR
SOMERVILLE MA
02145-1484
US

V. Phone/Fax

Practice location:
  • Phone: 978-741-1200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number1028115
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: