Provider Demographics
NPI:1285608950
Name:SHAHIN, KHALIL F (MD)
Entity type:Individual
Prefix:
First Name:KHALIL
Middle Name:F
Last Name:SHAHIN
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 1:100 CUMMINGS CTR STE 126Q
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-6117
Mailing Address - Country:US
Mailing Address - Phone:978-524-8181
Mailing Address - Fax:
Practice Address - Street 1:100 CUMMINGS CTR STE 126Q
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-6117
Practice Address - Country:US
Practice Address - Phone:978-524-8181
Practice Address - Fax:978-524-9868
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH12819207Q00000X
MA281668207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30205281Medicaid
NH3913760OtherCIGNA PIN
NH01YP08560NH01OtherANTHEM BCBS PIN
NH31130YOtherANTHEM REFERRING RAN
NH3965360OtherAETNA PIN
NH466560OtherTUFTS PIN
NHAA39921OtherHARVARD PILGRIM PIN
NH31130YOtherANTHEM REFERRING RAN