Basic Information
| Provider Information | |||||||||
| NPI: | 1659462083 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ZILBER | ||||||||
| FirstName: | DMITRIY | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 41 MALL RD | ||||||||
| Address2: | LAHEY CLINIC, INC | ||||||||
| City: | BURLINGTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018050001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9789271919 | ||||||||
| FaxNumber: | 9789276102 | ||||||||
| Practice Location | |||||||||
| Address1: | 152 CONANT ST | ||||||||
| Address2: | LAHEY BEVERLY | ||||||||
| City: | BEVERLY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 019151600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9789271919 | ||||||||
| FaxNumber: | 9789211254 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2006 | ||||||||
| LastUpdateDate: | 08/01/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | A89138 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 238221 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 110081636A | 05 | MA | MEDICAID | OOA891380 | 05 | CA | MEDICAID |