1043257546 NPI number — MARK V. ZILBERMAN M.D.

Table of content: MARK V. ZILBERMAN M.D. (NPI 1043257546)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043257546 NPI number — MARK V. ZILBERMAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZILBERMAN
Provider First Name:
MARK
Provider Middle Name:
V.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043257546
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/11/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 WASHINGTON ST
Provider Second Line Business Mailing Address:
#313
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02111-1552
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-636-5067
Provider Business Mailing Address Fax Number:
617-636-2354

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 WASHINGTON ST
Provider Second Line Business Practice Location Address:
#313
Provider Business Practice Location Address City Name:
BOSTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02111-1552
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-636-5067
Provider Business Practice Location Address Fax Number:
617-636-2354
Provider Enumeration Date:
06/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  242905 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2080P0202X , with the licence number: 242905 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: MZ082041 . This is a "CHAMPUS-CHAMPUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: MZ082041 . This is a "COMMERCIAL-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 700H262280 . This is a "BLUE CROSS-BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 481452710 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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