Provider Demographics
NPI:1376798728
Name:DIMITROV, DIMITAR ZHELYAZKOV (MD)
Entity Type:Individual
Prefix:DR
First Name:DIMITAR
Middle Name:ZHELYAZKOV
Last Name:DIMITROV
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 1:5730 EXECUTIVE DR STE 230
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-1762
Mailing Address - Country:US
Mailing Address - Phone:781-534-7100
Mailing Address - Fax:781-534-7358
Practice Address - Street 1:300 LINDEN PONDS WAY
Practice Address - Street 2:
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043-3791
Practice Address - Country:US
Practice Address - Phone:781-534-7100
Practice Address - Fax:781-534-7358
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-26
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA250923207RG0300X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY131740114OtherEIN