Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 250579-1 | NY |
N | 111NI0900X | Internist | 250579-1 | NY |
Y | 207RC0000X | Internist - Cardiovascular Disease | 245639 | MA |
NPI | 1003144528 |
---|---|
Provider Name | Dmitriy Kireyev |
First Address | Everett, MA 02149-5066 |
Second Address | Everett, MA 02149-5066 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2009 |
Last Update Date | 13/02/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110087726A | (05) | MA |