Provider Demographics
NPI:1255411070
Name:VASSERMAN, IRINA B (DPM)
Entity type:Individual
Prefix:DR
First Name:IRINA
Middle Name:B
Last Name:VASSERMAN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 CHAPMAN ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-2096
Mailing Address - Country:US
Mailing Address - Phone:781-575-1454
Mailing Address - Fax:781-575-1455
Practice Address - Street 1:510 CHAPMAN ST
Practice Address - Street 2:SUITE 1B
Practice Address - City:CANTON
Practice Address - State:MA
Practice Address - Zip Code:02021-2096
Practice Address - Country:US
Practice Address - Phone:781-575-1454
Practice Address - Fax:781-575-1455
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1982213E00000X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA333065OtherHPHC
MA728979OtherTUFTS
MAB20429901OtherCIGNA
MA4523040001OtherDME
MA0357863Medicaid
MA2700320OtherUNITED HEALTH CARE
MAY70960OtherBCBS
MA480033203OtherRRM
MA980614OtherAETNA
MAB20429901OtherCIGNA
MAU35033Medicare UPIN