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General NPI Number Information
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NPI Number | 1104076157
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Entity Type | Individual
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Provider Name | MARHAMA ALVI SHAH D.M.D
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Gender | Female
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Dates
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Enumeration Date | 09/26/2008
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Last Update Date | 09/26/2008
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Provider Practice Location Address
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Address Line | 124 COLLEGE AVE
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City | SOMERVILLE
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State | MA
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Zip | 02144-1919
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Country | US
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Telephone | 617-625-0543
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Fax |
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Provider Business Mailing Address
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Address Line | 660 WASHINGTON ST APT 16K
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City | BOSTON
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State | MA
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Zip | 02111-3228
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Country | US
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Telephone | 781-698-7245
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 22191
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License Number State | MA
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