Provider Demographics
NPI:1255691291
Name:GERMAK, MATTHEW (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:GERMAK
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 1:330 BROOKLINE AVE
Mailing Address - Street 2:BIDMC - HEALTHCARE ASSOC, E/SHAPIRO
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-5400
Mailing Address - Country:US
Mailing Address - Phone:617-754-9600
Mailing Address - Fax:617-667-8665
Practice Address - Street 1:330 BROOKLINE AVE
Practice Address - Street 2:BIDMC - HEALTHCARE ASSOC, E/SHAPIRO
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5400
Practice Address - Country:US
Practice Address - Phone:617-754-9600
Practice Address - Fax:617-667-8665
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-24
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RILP02450207R00000X, 208000000X
MA266045207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics