Basic Information
| Provider Information | |||||||||
| NPI: | 1255467965 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DHAR | ||||||||
| FirstName: | SHUSMITA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 454 BROADWAY | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | REVERE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021513034 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7814858222 | ||||||||
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| Practice Location | |||||||||
| Address1: | 300 NEEDHAM ST STE 1B | ||||||||
| Address2: | |||||||||
| City: | NEWTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024641572 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6179035000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/26/2007 | ||||||||
| LastUpdateDate: | 01/26/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 233935 | MA | N | Allopathic & Osteopathic Physicians | Pediatrics | 207R00000X | 233935 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 110080127A | 05 | MA | MEDICAID |