Provider Demographics
NPI:1245236389
Name:CHAVIN, VICKI ALBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:VICKI
Middle Name:ALBERT
Last Name:CHAVIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:223 WALNUT ST
Mailing Address - Street 2:STE 4
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-7500
Mailing Address - Country:US
Mailing Address - Phone:508-872-6862
Mailing Address - Fax:508-872-6884
Practice Address - Street 1:223 WALNUT ST
Practice Address - Street 2:STE 4
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-7500
Practice Address - Country:US
Practice Address - Phone:508-872-6862
Practice Address - Fax:508-872-6884
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-23
Last Update Date:2008-06-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA80705207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ16039Medicare ID - Type Unspecified