Healthcare Provider Details

I. General information

NPI: 1376798728
Provider Name (Legal Business Name): DIMITAR ZHELYAZKOV DIMITROV M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/26/2008
Last Update Date: 10/12/2023
Certification Date: 10/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LINDEN PONDS WAY
HINGHAM MA
02043-3791
US

IV. Provider business mailing address

5730 EXECUTIVE DR STE 230
CATONSVILLE MD
21228-1762
US

V. Phone/Fax

Practice location:
  • Phone: 781-534-7100
  • Fax: 781-534-7358
Mailing address:
  • Phone: 781-534-7100
  • Fax: 781-534-7358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number250923
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number250923
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: