Provider Demographics
NPI:1952303745
Name:SKURLATOVA-MAYSKY, IRINA (MD)
Entity Type:Individual
Prefix:
First Name:IRINA
Middle Name:
Last Name:SKURLATOVA-MAYSKY
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 1:319 ALLSTON ST
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-7652
Mailing Address - Country:US
Mailing Address - Phone:617-734-1300
Mailing Address - Fax:617-734-1330
Practice Address - Street 1:319 ALLSTON ST
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-7652
Practice Address - Country:US
Practice Address - Phone:617-734-1300
Practice Address - Fax:617-734-1330
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA156221207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3187403Medicaid
MA3187403Medicaid
MAA28850Medicare ID - Type Unspecified