Provider Demographics
NPI:1013995992
Name:GUREVICH, IRINA (MD)
Entity Type:Individual
Prefix:DR
First Name:IRINA
Middle Name:
Last Name:GUREVICH
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 1:275 SANDWICH ST
Mailing Address - Street 2:C/O CATHY GREY
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-2183
Mailing Address - Country:US
Mailing Address - Phone:508-830-2390
Mailing Address - Fax:508-830-2399
Practice Address - Street 1:275 SANDWICH ST
Practice Address - Street 2:C/O CATHY GREY
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-2183
Practice Address - Country:US
Practice Address - Phone:508-830-2390
Practice Address - Fax:508-830-2399
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA152492207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA152492OtherTUFTS HEALTH PLAN
MA0170836Medicaid
MA14771OtherHARVARD PILGRIM
MAJ24893OtherBCBSMA
MA152492OtherTUFTS HEALTH PLAN
MAA33951Medicare PIN