Provider Demographics
NPI:1851084990
Name:DIMITROV, DIMO DIMCHEV (MD)
Entity Type:Individual
Prefix:
First Name:DIMO
Middle Name:DIMCHEV
Last Name:DIMITROV
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 1:763 CAMBRIDGE STREET
Mailing Address - Street 2:MOB SUITE 308
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135
Mailing Address - Country:US
Mailing Address - Phone:617-779-6342
Mailing Address - Fax:
Practice Address - Street 1:763 CAMBRIDGE STREET
Practice Address - Street 2:MOB SUITE 308
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02135
Practice Address - Country:US
Practice Address - Phone:617-779-6342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-02
Last Update Date:2024-01-12
Deactivation Date:2024-01-05
Deactivation Code:
Reactivation Date:2024-01-12
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program