MEDICARE: DR. DENNIS M DIMITRI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	46145	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	705233	OTHER	TUFTS HEALTH PLAN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	7150	OTHER	HARVARD PILGRIM HEALTH
4	4116	OTHER	FALLEN COMMUNITY HEALTH

General Provider Information

NPI Number	:	1902883499
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DENNIS M DIMITRI MD

Provider Business Mailing Address
First Line	:	PO BOX 415348
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02241-5348
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	295 LINCOLN ST
Second Line	:	SUITE 204
City	:	WORCESTER
State	:	MA
Zip	:	01605-3639
Country	:	US
Telephone Number	:	508-757-5520
Fax Number	:	508-797-0360

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/27/2005
Last Update Date	:	12/15/2020

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