Individual
DR. JOANNE OMALLEY SHEPARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
55 FRUIT STREET, FND 2, BOSTON, MA 02114-2696
(617) 724-4256
(617) 724-0046
Mailing address
PO BOX 9142, MASS GENERAL PHYSICIAN ORGANIZATION, CHARLESTOWN, MA 02129-9142
(617) 724-4256
(617) 724-0046
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
014403
ME
2085R0202X
Diagnostic Radiology Physician
211708
NY
2085R0202X
Diagnostic Radiology Physician
Primary
43700
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0145904
—
MA
01
—
724090
TUFTS HEALTH PLAN
MA
01
—
C05306
BCBS MA
MA
Enumeration date
11/02/2005
Last updated
08/09/2012
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