Provider Demographics
NPI:1053322925
Name:MAKI, DENNIS W (MD)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:W
Last Name:MAKI
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:PO BOX 415348
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-5348
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:55 LAKE AVE N
Practice Address - Street 2:ACC BUILDING DEPT OF CARDIOLOGY
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01655-0002
Practice Address - Country:US
Practice Address - Phone:508-334-3452
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA39744207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
2069628OtherWELFARE
4065786OtherAETNA
28010OtherCHILDRENS MED SECURITY PL
28010OtherHEALTHY START
N01811OtherMEDICARE B
042472266OtherONE HEALTH PLAN
042472266OtherPRIVATE HEALTHCARE SYSTEM
4065786OtherUS HEALTHCARE
9900080OtherFALLON COMM HEALTH PLAN
042472266OtherHEALTHCARE VALUE MGMT
784048OtherMVP HEALTH CARE
042472266OtherTHREE RIVERS
9526220OtherCIGNA HEALTH PLAN
AA2360OtherHARVARD PILGRIM HEALTHCAR
060056682OtherRAILROAD MEDICARE
MA2069628Medicaid
917934OtherFIRST HEALTH
N01811OtherBLUE CROSS
9900080OtherFALLON COMM HEALTH PLAN
2069628OtherWELFARE