Provider Demographics
NPI:1992779037
Name:NAHAR, SHAMSUN (MD)
Entity type:Individual
Prefix:
First Name:SHAMSUN
Middle Name:
Last Name:NAHAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 FEDERAL ST
Mailing Address - Street 2:LAHEY HEALTH PRIMARY CARE, DANVERS
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-5504
Mailing Address - Country:US
Mailing Address - Phone:978-774-0730
Mailing Address - Fax:978-750-0246
Practice Address - Street 1:5 FEDERAL ST
Practice Address - Street 2:LAHEY HEALTH PRIMARY CARE, DANVERS
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-5504
Practice Address - Country:US
Practice Address - Phone:978-774-0730
Practice Address - Fax:978-750-0246
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101228203207R00000X
MA239533207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA541595397OtherTRICARE
VA541595397OtherVIRGINIA HEALTH NETWORK
VA541595397OtherMID ATLANTIC SOLUTIONS
VA7819195OtherAETNA
VA104144OtherANTHEM
VA541595397OtherCIGNA
VA010048541Medicaid
VA39740OtherSENTARA/OPTIMA
VA541595397OtherPRIVATE HEALTHCARE SYSTEM
VA541595397OtherCIGNA
MA002581301Medicare PIN
VA010048541Medicaid