Healthcare Provider Details

I. General information

NPI: 1992952055
Provider Name (Legal Business Name): DZIALO PHYSIATRY CONSULTING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2008
Last Update Date: 12/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 COMMONWEALTH AVE.
BRIGHTON MA
02135-3617
US

IV. Provider business mailing address

P.O. BOX 129
DANVERS MA
01923-0229
US

V. Phone/Fax

Practice location:
  • Phone: 617-254-1100
  • Fax: 617-783-1813
Mailing address:
  • Phone: 978-762-4888
  • Fax: 978-762-3922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number212681
License Number StateMA

VIII. Authorized Official

Name: ANN FRANCINE DZIALO
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 978-302-8855