Basic Information
| Provider Information | |||||||||
| NPI: | 1982799854 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHAKUR | ||||||||
| FirstName: | UMAR | ||||||||
| MiddleName: | MUHAMMAD | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2100 DORCHESTER AVE | ||||||||
| Address2: | DEPARTMENT OF CARDIOLOGY | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021245615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6172964000 | ||||||||
| FaxNumber: | 6174743860 | ||||||||
| Practice Location | |||||||||
| Address1: | 2 HAYWARD ST | ||||||||
| Address2: | |||||||||
| City: | ATTLEBORO | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027032113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5084313600 | ||||||||
| FaxNumber: | 5084312545 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2006 | ||||||||
| LastUpdateDate: | 08/08/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 258854 | MA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | DO00662 | RI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0000X | 258854 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 110087905A | 05 | MA | MEDICAID | US82064 | 05 | RI | MEDICAID |