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General NPI Number Information
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NPI Number | 1457340515
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Entity Type | Individual
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Provider Name | NATALIA GANSON-MYSHKIN M.D.
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Gender | Female
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Dates
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Enumeration Date | 10/20/2005
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Last Update Date | 09/02/2015
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Provider Practice Location Address
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Address Line | 2110 DORCHESTER AVE
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City | DORCHESTER CENTER
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State | MA
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Zip | 02124-5628
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Country | US
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Telephone | 617-436-3786
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Fax | 617-296-5778
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Provider Business Mailing Address
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Address Line | 2110 DORCHESTER AVE STE 311 SETON MEDICAL OFFICE BUILDING
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City | DORCHESTER
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State | MA
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Zip | 02124-5615
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Country | US
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Telephone | 617-296-0456
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 75596
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License Number State | MA
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