Provider Demographics
NPI:1508208505
Name:SEMENOV, YEVGENIY ROMANOVICH (MD, MA)
Entity Type:Individual
Prefix:DR
First Name:YEVGENIY
Middle Name:ROMANOVICH
Last Name:SEMENOV
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Gender:M
Credentials:MD, MA
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Mailing Address - Street 1:MASSACHUSETTS GENERAL HOSPITAL - DEPT OF DERMATOLOGY
Mailing Address - Street 2:55 FRUIT STREET
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114
Mailing Address - Country:US
Mailing Address - Phone:617-724-6973
Mailing Address - Fax:
Practice Address - Street 1:MASSACHUSETTS GENERAL HOSPITAL - DEPT OF DERMATOLOGY
Practice Address - Street 2:55 FRUIT STREET
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114
Practice Address - Country:US
Practice Address - Phone:617-724-6973
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-19
Last Update Date:2019-09-18
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Provider Licenses
StateLicense IDTaxonomies
MA278563207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1508208505Medicaid