Provider Demographics
NPI:1972555373
Name:VISHNIAVSKY, NAHUM (MD)
Entity Type:Individual
Prefix:
First Name:NAHUM
Middle Name:
Last Name:VISHNIAVSKY
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 1:147 MILK ST
Mailing Address - Street 2:PROVIDER ENROLLMENT - 9TH FLOOR
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02109-4806
Mailing Address - Country:US
Mailing Address - Phone:617-559-8374
Mailing Address - Fax:
Practice Address - Street 1:230 WORCESTER ST
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-5420
Practice Address - Country:US
Practice Address - Phone:781-431-5460
Practice Address - Fax:781-431-5465
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA53814207RI0200X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0017935OtherNEIGHBORHOOD HEALTH
MA053814OtherTUFTS
MA3111806Medicaid
MAJ10735OtherBLUE CROSS
MAM352OtherHARVARD PILGRIM
MAJ10735Medicare PIN
MAJ10735OtherBLUE CROSS