{
"Npi": {
"NPI": "1467608836",
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"ReplacementNPI": null,
"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MDFPR",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "32 QUARRY RD APT 33",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WATERVILLE",
"MailingAddressStateName": "ME",
"MailingAddressPostalCode": "04901-4970",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "415-314-0144",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "15 E CHESTNUT ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "AUGUSTA",
"PracticeLocationAddressStateName": "ME",
"PracticeLocationAddressPostalCode": "04330-5736",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "207-626-1889",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "08/17/2008",
"LastUpdateDate": "08/17/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BEREJNOI",
"AuthorizedOfficialFirstName": "KIRILL",
"AuthorizedOfficialMiddleName": "V",
"AuthorizedOfficialTitle": "GERIATRICIAN",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.D.,",
"AuthorizedOfficialTelephoneNumber": "415-314-0144",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QM1300X",
"TaxonomyName": "Multi-Specialty Clinic/Center",
"LicenseNumber": "A102844",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}