Provider Demographics
NPI:1114981073
Name:MEZHEBOVSKY, IRINA Y (MD)
Entity Type:Individual
Prefix:DR
First Name:IRINA
Middle Name:Y
Last Name:MEZHEBOVSKY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 HIGHLAND TER
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02494-3014
Mailing Address - Country:US
Mailing Address - Phone:781-455-6609
Mailing Address - Fax:781-455-6609
Practice Address - Street 1:300 SOUTH ST
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02467-3658
Practice Address - Country:US
Practice Address - Phone:617-469-0300
Practice Address - Fax:617-783-0395
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA150235174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3171051Medicaid
MAA22696Medicare ID - Type Unspecified
MA3171051Medicaid