Provider Demographics
NPI:1932332681
Name:SIRAKOV, DIMITRE (MD)
Entity Type:Individual
Prefix:
First Name:DIMITRE
Middle Name:
Last Name:SIRAKOV
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 1:275 VARNUM AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01854-2141
Mailing Address - Country:US
Mailing Address - Phone:978-452-9700
Mailing Address - Fax:978-441-6075
Practice Address - Street 1:275 VARNUM AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01854-2141
Practice Address - Country:US
Practice Address - Phone:978-452-9700
Practice Address - Fax:978-441-6075
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-28
Last Update Date:2009-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA241468207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine