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Individual

DR. PAUL CLARKE SHELLITO

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
15 PARKMAN ST, WAC 460, BOSTON, MA 02114-3117
(617) 724-0365
(617) 724-3943
Mailing address
PO BOX 9142, MASS GENERAL PHYSICIAN ORGANIZATION, CHARLESTOWN, MA 02129-9142
(617) 724-0287
(617) 726-2894

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
49343
MA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
6199267
MA
01
714301
TUFTS HEALTH PLAN
MA
01
E05768
BCBS MA
MA
Enumeration date
10/25/2005
Last updated
07/08/2007
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