Provider Demographics
NPI:1467443465
Name:DZIALO, ANN FRANCINE (MD)
Entity Type:Individual
Prefix:DR
First Name:ANN
Middle Name:FRANCINE
Last Name:DZIALO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:P.O. BOX 129
Mailing Address - Street 2:
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-0229
Mailing Address - Country:US
Mailing Address - Phone:978-762-4888
Mailing Address - Fax:978-762-3922
Practice Address - Street 1:1515 COMMONWEALTH AVE.
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-3617
Practice Address - Country:US
Practice Address - Phone:617-254-1100
Practice Address - Fax:617-783-1803
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-31
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA212681208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0156841Medicaid
A33506Medicare UPIN
MA0156841Medicaid
MAH54273Medicare UPIN