Provider Demographics
NPI:1386609907
Name:MASHALI, FATHALLA (MD)
Entity type:Individual
Prefix:
First Name:FATHALLA
Middle Name:
Last Name:MASHALI
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 1:10 CONVERSE PL
Mailing Address - Street 2:SUITE 4
Mailing Address - City:WINCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01890-2713
Mailing Address - Country:US
Mailing Address - Phone:781-729-0500
Mailing Address - Fax:781-729-0581
Practice Address - Street 1:10 CONVERSE PL
Practice Address - Street 2:SUITE 4
Practice Address - City:WINCHESTER
Practice Address - State:MA
Practice Address - Zip Code:01890-2713
Practice Address - Country:US
Practice Address - Phone:781-729-0500
Practice Address - Fax:781-729-0581
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA152670207L00000X, 207LC0200X
RIMD09332207L00000X, 207LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
050091454OtherRAILROAD
MA251516OtherFIRST HEALTH
RI408547OtherBLUE CHIP
4268OtherNHP
MA65315OtherFHP
MAAA64197OtherHPHC
MAJ17353OtherBCBS
MA3787519OtherAETNA
3799831OtherAETNA
RI7005612Medicaid
P00069529OtherRAILROAD
050092409OtherRAILROAD
MA202010504OtherCHOICECARE
MA276127OtherHPHC
MA3160840Medicaid
MAAA81270OtherHPHC
0010025OtherNHP
RI405332OtherBLUE CHIP
MA5253541OtherAETNA
MAAA20850OtherHPHC
MA152670OtherTUFTS
MA97394803OtherNETWORK HEALTH
MAAA30508OtherHPHC
MA000000029495OtherBMC
MA202010504OtherGREATWEST
NH30207078Medicaid
MA973948OtherTUFTS
P00391599OtherRAILROAD
0028221OtherNHP
4306245OtherCIGNA
MA4306245OtherCIGNA
MAAA20850OtherHPHC
0010025OtherNHP
MA3787519OtherAETNA
4306245OtherCIGNA
MA4306245OtherCIGNA