Provider Demographics
NPI:1295898401
Name:MIRSKY, DAVID PAUL (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:PAUL
Last Name:MIRSKY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:68 HYDE ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON HIGHLANDS
Mailing Address - State:MA
Mailing Address - Zip Code:02461-1206
Mailing Address - Country:US
Mailing Address - Phone:617-332-6595
Mailing Address - Fax:508-529-7024
Practice Address - Street 1:206 MILFORD ST
Practice Address - Street 2:RIVERSIDE COMMUNITY CARE
Practice Address - City:UPTON
Practice Address - State:MA
Practice Address - Zip Code:01568-1309
Practice Address - Country:US
Practice Address - Phone:508-529-7000
Practice Address - Fax:508-529-7024
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA294042084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
A65961Medicare UPIN
MAM07595Medicare ID - Type Unspecified