Healthcare Provider Details

I. General information

NPI: 1912121476
Provider Name (Legal Business Name): MARY R SHOEMAKER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 01/25/2023
Certification Date: 01/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

152 DEAN ST
TAUNTON MA
02780-2766
US

IV. Provider business mailing address

22 PATRIOT PL FL 4
FOXBORO MA
02035-1375
US

V. Phone/Fax

Practice location:
  • Phone: 508-824-3872
  • Fax: 508-822-7975
Mailing address:
  • Phone: 508-718-4050
  • Fax: 508-718-4051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number221409
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: