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General NPI Number Information
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NPI Number | 1710980230
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Entity Type | Individual
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Provider Name | JAHANSOUZ SHOKRI M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/30/2005
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Last Update Date | 11/17/2020
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Provider Practice Location Address
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Address Line | 485 ARSENAL ST INTERNAL MEDICINE
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City | WATERTOWN
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State | MA
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Zip | 02472-5091
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Country | US
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Telephone | 617-972-5240
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Fax | 617-972-5512
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Provider Business Mailing Address
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Address Line | 485 ARSENAL ST INTERNAL MEDICINE
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City | WATERTOWN
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State | MA
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Zip | 02472-5091
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Country | US
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Telephone | 617-972-5240
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Fax | 617-972-5512
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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 | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | 2004027804
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 230266
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License Number State | MA
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