Provider Demographics
NPI:1396716882
Name:DOBKIN, GARY RICHARD (MD)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:RICHARD
Last Name:DOBKIN
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 1:24 POND CIR
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02130-2421
Mailing Address - Country:US
Mailing Address - Phone:617-522-3848
Mailing Address - Fax:
Practice Address - Street 1:55 POND AVE
Practice Address - Street 2:SUITE 201E
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-7102
Practice Address - Country:US
Practice Address - Phone:617-232-4600
Practice Address - Fax:617-232-4405
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA543372085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3004431Medicaid
MAJ04962Medicare ID - Type Unspecified
MA3004431Medicaid