Basic Information
| Provider Information | |||||||||
| NPI: | 1609802180 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RAMCHANDANI | ||||||||
| FirstName: | SHIRLY | ||||||||
| MiddleName: | HASHUMAL | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 147 MILK ST | ||||||||
| Address2: | PROVIDER ENROLLMENT - 9TH FLOOR | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021094806 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6175598374 | ||||||||
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| Practice Location | |||||||||
| Address1: | 11 NEVINS ST STE 304 | ||||||||
| Address2: | |||||||||
| City: | BRIGHTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021353514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8572420070 | ||||||||
| FaxNumber: | 6175620600 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2006 | ||||||||
| LastUpdateDate: | 07/19/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RB0002X | 156897 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Bariatric Medicine | 207R00000X | 156897 | MA | N | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0018929 | 01 | MA | NEIGHBORHOOD HEALTH | OTHER | J18931 | 01 | MA | BLUE CROSS | OTHER | 156897 | 01 | MA | TUFTS | OTHER | V933 | 01 | MA | HARVRD PILGRIM | OTHER | 3178749 | 05 | MA | MEDICAID |