=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457344574
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN MASHIKIAN MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/24/2005
-----------------------------------------------------
Last Update Date | 06/25/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 680 CENTRE ST
-----------------------------------------------------
City | BROCKTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02302-3308
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-490-2130
-----------------------------------------------------
Fax | 401-435-2483
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 690 CANTON ST SUITE 325
-----------------------------------------------------
City | WESTWOOD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02090-2321
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-407-7713
-----------------------------------------------------
Fax | 781-407-0998
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number | MD11923
-----------------------------------------------------
License Number State | RI
-----------------------------------------------------