Provider Demographics
NPI:1043257546
Name:ZILBERMAN, MARK V (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:V
Last Name:ZILBERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 WASHINGTON ST
Mailing Address - Street 2:#313
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111-1552
Mailing Address - Country:US
Mailing Address - Phone:617-636-5067
Mailing Address - Fax:617-636-2354
Practice Address - Street 1:800 WASHINGTON ST
Practice Address - Street 2:#313
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-1552
Practice Address - Country:US
Practice Address - Phone:617-636-5067
Practice Address - Fax:617-636-2354
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA242905208000000X, 2080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MZ082041OtherCHAMPUS-CHAMPUS
MZ082041OtherCOMMERCIAL-COMMERCIAL NUMBER
700H262280OtherBLUE CROSS-BLUE CROSS
MI481452710Medicaid
I22045Medicare UPIN
0H26228343Medicare ID - Type Unspecified