Provider Demographics
NPI:1316176688
Name:SHKOLNIK, LAUREN (DO)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:SHKOLNIK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 HIGHLAND AVE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-2185
Mailing Address - Country:US
Mailing Address - Phone:978-741-4171
Mailing Address - Fax:978-741-4283
Practice Address - Street 1:55 HIGHLAND AVE
Practice Address - Street 2:SUITE 304
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-2185
Practice Address - Country:US
Practice Address - Phone:978-741-4171
Practice Address - Fax:978-741-4283
Is Sole Proprietor?:No
Enumeration Date:2009-07-08
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA250342207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110092493AMedicaid
MA110092493AMedicaid