Healthcare Provider Details

I. General information

NPI: 1043257546
Provider Name (Legal Business Name): MARK V. ZILBERMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 04/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 WASHINGTON ST #313
BOSTON MA
02111-1552
US

IV. Provider business mailing address

800 WASHINGTON ST #313
BOSTON MA
02111-1552
US

V. Phone/Fax

Practice location:
  • Phone: 617-636-5067
  • Fax: 617-636-2354
Mailing address:
  • Phone: 617-636-5067
  • Fax: 617-636-2354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number242905
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number242905
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: