Provider Demographics
NPI:1174504526
Name:DWORKIND, MARCIA F (MD)
Entity Type:Individual
Prefix:DR
First Name:MARCIA
Middle Name:F
Last Name:DWORKIND
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 1:40 HOLLAND ST
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02144-2705
Mailing Address - Country:US
Mailing Address - Phone:617-629-6300
Mailing Address - Fax:617-629-6090
Practice Address - Street 1:40 HOLLAND ST
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02144-2705
Practice Address - Country:US
Practice Address - Phone:617-629-6300
Practice Address - Fax:617-629-6090
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2021-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA72376208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3064492Medicaid
MA996682OtherNH
MADWJ10678OtherBCBS
MA0004965OtherNHP
MA0075373OtherAETNA
MA714955OtherTHP
MA9949769002OtherCIGNA
MADWJ10678OtherBCBS