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NPI Code Detail

MEDICARE: DR. JAHANSOUZ SHOKRI M.D.

MEDICARE: DR. JAHANSOUZ SHOKRI M.D.
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
1207RC0200XCritical Care Medicine (Internal Medicine) Physician2004027804MO
2207R00000XInternal Medicine Physician230266MA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1710980230
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JAHANSOUZ SHOKRI M.D.
Provider Business Mailing Address
First Line : 485 ARSENAL ST
Second Line : INTERNAL MEDICINE
City : WATERTOWN
State : MA
Zip : 02472-5091
Country : US
Telephone Number : 617-972-5240
Fax Number : 617-972-5512
Provider Business Practice Location Address
First Line : 485 ARSENAL ST
Second Line : INTERNAL MEDICINE
City : WATERTOWN
State : MA
Zip : 02472-5091
Country : US
Telephone Number : 617-972-5240
Fax Number : 617-972-5512
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/30/2005
Last Update Date : 11/17/2020

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