Provider Demographics
NPI:1033107693
Name:GREGORY TALALAYEVSKY, MD PC
Entity Type:Organization
Organization Name:GREGORY TALALAYEVSKY, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:TALALAYEVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-364-6221
Mailing Address - Street 1:1272 HYDE PARK AVE
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:MA
Mailing Address - Zip Code:02136-2702
Mailing Address - Country:US
Mailing Address - Phone:617-364-6221
Mailing Address - Fax:617-364-7661
Practice Address - Street 1:1272 HYDE PARK AVE NUM 74
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:MA
Practice Address - Zip Code:02136-2702
Practice Address - Country:US
Practice Address - Phone:617-364-6221
Practice Address - Fax:617-272-3640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA51654207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ02713Medicare ID - Type Unspecified
MAA56820Medicare UPIN
MAA56820Medicare UPIN
MA61610OtherHPHC
MAJ02713OtherBCBS MA
MA3010520Medicaid