Provider Demographics
NPI:1922480391
Name:EZZEDINE, DIMA (MD)
Entity Type:Individual
Prefix:DR
First Name:DIMA
Middle Name:
Last Name:EZZEDINE
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 1:115 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-6358
Mailing Address - Country:US
Mailing Address - Phone:508-383-1000
Mailing Address - Fax:
Practice Address - Street 1:45 HOME DEPOT DR STE 100
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-2669
Practice Address - Country:US
Practice Address - Phone:781-762-0471
Practice Address - Fax:973-290-7520
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-22
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA264000207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology