Provider Demographics
NPI:1659462083
Name:ZILBER, DMITRIY (MD)
Entity Type:Individual
Prefix:
First Name:DMITRIY
Middle Name:
Last Name:ZILBER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 MALL RD
Mailing Address - Street 2:LAHEY CLINIC, INC
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01805-0001
Mailing Address - Country:US
Mailing Address - Phone:978-927-1919
Mailing Address - Fax:978-927-6102
Practice Address - Street 1:152 CONANT ST
Practice Address - Street 2:LAHEY BEVERLY
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-1600
Practice Address - Country:US
Practice Address - Phone:978-927-1919
Practice Address - Fax:978-921-1254
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA89138207R00000X
MA238221207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110081636AMedicaid
CAOOA891380Medicaid
MA000972001Medicare PIN
I23109Medicare UPIN