Individual
SHANNON BOTTARI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
585 LEBANON ST, MELROSE, MA 02176-3225
(781) 937-4522
Mailing address
12 GILL ST, STE 3000, WOBURN, MA 01801-1728
(781) 937-4522
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
225017
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2126966
—
MA
01
—
J40959
BLUE SHIELD
MA
Enumeration date
07/24/2006
Last updated
04/23/2008
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