Healthcare Provider Details

I. General information

NPI: 1629015383
Provider Name (Legal Business Name): IVAN T VALOVSKI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 05/14/2020
Certification Date: 05/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 VFW PKWY VA BOSTON HEALTH CARE SYSTEM
WEST ROXBURY MA
02132-4927
US

IV. Provider business mailing address

3 MARIE PATH
NATICK MA
01760-4172
US

V. Phone/Fax

Practice location:
  • Phone: 617-323-7700
  • Fax: 617-323-5777
Mailing address:
  • Phone: 617-323-7700
  • Fax: 617-323-5777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number216372
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number216372
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: