Provider Demographics
NPI:1407924947
Name:ZILBERMAN, IRINA S (MD)
Entity Type:Individual
Prefix:
First Name:IRINA
Middle Name:S
Last Name:ZILBERMAN
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 1:800 WASHINGTO ST, #401
Mailing Address - Street 2:TUFTS MEDICAL CENTER
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111
Mailing Address - Country:US
Mailing Address - Phone:617-636-3379
Mailing Address - Fax:617-636-8848
Practice Address - Street 1:800 WASHINGTON ST
Practice Address - Street 2:#401
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-1552
Practice Address - Country:US
Practice Address - Phone:617-636-3379
Practice Address - Fax:617-636-8848
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2010-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI082605207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
700H262220OtherBLUE CROSS-BLUE CROSS
IZ082605OtherCHAMPUS-CHAMPUS
IZ082605OtherCOMMERCIAL-COMMERCIAL NUMBER
MI472450010Medicaid
IZ082605OtherCOMMERCIAL-COMMERCIAL NUMBER
IZ082605OtherCHAMPUS-CHAMPUS