Provider Demographics
NPI:1619908456
Name:PLOTKIN, IGOR M (MD)
Entity Type:Individual
Prefix:
First Name:IGOR
Middle Name:M
Last Name:PLOTKIN
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:PO BOX 414628
Mailing Address - Street 2:C/O PAR MGMT
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-4628
Mailing Address - Country:US
Mailing Address - Phone:781-449-6150
Mailing Address - Fax:781-449-3970
Practice Address - Street 1:2014 WASHINGTON ST
Practice Address - Street 2:DEPT OF ANESTHESIA
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02462
Practice Address - Country:US
Practice Address - Phone:617-243-6298
Practice Address - Fax:617-243-6184
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA151246207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3158047Medicaid
PLA22077Medicare ID - Type Unspecified
G40742Medicare UPIN