Provider Demographics
NPI:1427436807
Name:BEVERLY SHAFER, MD, PC
Entity type:Organization
Organization Name:BEVERLY SHAFER, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAFER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-927-8844
Mailing Address - Street 1:900 CUMMINGS CTR
Mailing Address - Street 2:SUITE 112W
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-6198
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:900 CUMMINGS CTR
Practice Address - Street 2:SUITE 112W
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-6198
Practice Address - Country:US
Practice Address - Phone:978-927-8844
Practice Address - Fax:978-927-8845
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BEVERLY SHAFER, MD, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-05-18
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA577822086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty