Provider Demographics
NPI:1487644076
Name:MILLS, DIXIE (MD)
Entity Type:Individual
Prefix:
First Name:DIXIE
Middle Name:
Last Name:MILLS
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 1:133 BROOKLINE AVE
Mailing Address - Street 2:SURGERY DEPT
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-3904
Mailing Address - Country:US
Mailing Address - Phone:617-421-8749
Mailing Address - Fax:617-421-2236
Practice Address - Street 1:133 BROOKLINE AVE
Practice Address - Street 2:SURGERY DEPT
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-3904
Practice Address - Country:US
Practice Address - Phone:617-421-8749
Practice Address - Fax:617-421-2236
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME014156208600000X
CAG87842208600000X
MA70497208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110014264AMedicaid
MAJ0926801Medicare PIN
MA110014264AMedicaid