Provider Demographics
NPI:1194253880
Name:KARLS, SHAWN (MD)
Entity type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:
Last Name:KARLS
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 1:560 1ST AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-6402
Mailing Address - Country:US
Mailing Address - Phone:617-959-5709
Mailing Address - Fax:
Practice Address - Street 1:560 1ST AVE FL 2
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016
Practice Address - Country:US
Practice Address - Phone:617-959-5709
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-25
Last Update Date:2018-06-06
Deactivation Date:2018-01-02
Deactivation Code:
Reactivation Date:2018-01-12
Provider Licenses
StateLicense IDTaxonomies
390200000X
MA270455390200000X
NY2935392085N0904X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program