Provider Demographics
NPI:1164098117
Name:YIBIRIN, MARCEL JOSE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARCEL
Middle Name:JOSE
Last Name:YIBIRIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MARCEL
Other - Middle Name:JOSE
Other - Last Name:YIBIRIN WAKIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:960 MASSACHUSETTS AVE
Mailing Address - Street 2:FL 2
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2690
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:800 MASSACHUSETTS AVE
Practice Address - Street 2:CROSSTOWN BLDG
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2605
Practice Address - Country:US
Practice Address - Phone:617-414-5951
Practice Address - Fax:617-414-9201
Is Sole Proprietor?:No
Enumeration Date:2021-06-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1018056207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine