Provider Demographics
NPI:1619979408
Name:NATAPOV, IRINA G (MD)
Entity Type:Individual
Prefix:
First Name:IRINA
Middle Name:G
Last Name:NATAPOV
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 1:34 STATE ST
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01901-1505
Mailing Address - Country:US
Mailing Address - Phone:781-581-6181
Mailing Address - Fax:
Practice Address - Street 1:34 STATE ST
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01901-1505
Practice Address - Country:US
Practice Address - Phone:781-581-6181
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA151665207R00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3169065Medicaid
MA3169065Medicaid
MAA22666Medicare ID - Type Unspecified