MEDICARE: DR. JEFFRY R SHAEFER DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	15402	MA
2	1223X2210X	Orofacial Pain Dentistry	15402	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	015402	OTHER	MA	TUFTS HEALTH PLAN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306822606
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFRY R SHAEFER DDS

Provider Business Mailing Address
First Line	:	PO BOX 9142
Second Line	:	MASS GENERAL PHYSICIAN ORGANIZATION
City	:	CHARLESTOWN
State	:	MA
Zip	:	02129-9142
Country	:	US
Telephone Number	:	617-724-0287
Fax Number	:	617-726-2894

Provider Business Practice Location Address
First Line	:	188 LONGWOOD AVENUE
Second Line	:	HARVARD FACULTY GROUP PRACTICE
City	:	BOSTON
State	:	MA
Zip	:	02115
Country	:	US
Telephone Number	:	617-432-3153
Fax Number	:	617-498-1205

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/19/2005
Last Update Date	:	10/02/2020

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