Provider Demographics
NPI:1104895622
Name:SHINE, WILLIAM J (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:J
Last Name:SHINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 INDUSTRIAL RD STE 5
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-3736
Mailing Address - Country:US
Mailing Address - Phone:508-473-1480
Mailing Address - Fax:508-634-0261
Practice Address - Street 1:308 MAIN ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-2511
Practice Address - Country:US
Practice Address - Phone:508-731-2560
Practice Address - Fax:508-731-2561
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA71546207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
060049122OtherRR MEDICARE
14115OtherFALLON
MA0024703OtherNEIGHBORHOOD HEALTH PLAN
MAJ09850OtherBCBS
3954OtherHPHC
MA3061485Medicaid
732036OtherTUFTS
MA3061485Medicaid
14115OtherFALLON