Physician Compare National (NPI:1053428474)

HEALTHCARE PROVIDER: MARVIN KONSTAM MD

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1053428474
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	1557338050
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20050725000359
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	KONSTAM
	Individual professional last name
Provider First Name	MARVIN
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.
Provider Credential Text	MD
	The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.

Medical School Information
Medical School Name	COLUMBIA UNIVERSITY COLLEGE OF PHYSICIANS AND SURGEONS
	Individual professional's medical school
Graduation Year	1975
	Individual professional's medical school graduation year
Primary Specialty	ADVANCED HEART FAILURE AND TRANSPLANT CARDIOLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	CARDIOVASCULAR DISEASE (CARDIOLOGY)
	First secondary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 2	DIAGNOSTIC RADIOLOGY
	Second secondary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 3	INTERNAL MEDICINE
	Third secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	CARDIOVASCULAR DISEASE (CARDIOLOGY), DIAGNOSTIC RADIOLOGY, INTERNAL MEDICINE
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Organization Legal Name	CARDIOVASCULAR CENTER AT TUFTS MEDICAL CENTER INC
	Legal name of the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Group Practice PAC ID	3870857816
	Unique Group Practice ID assigned by PECOS to the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Number of Group Practice members	68
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	800 WASHINGTON ST
	Group Practice or individual's line 1 address
City	BOSTON
	Group Practice or individual's city
State	MA
	Group Practice or individual's state
Zip Code	021111552
	Group Practice or individual's zip code (9 digits when available)
Phone Number	6176365000
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	220116
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	TUFTS MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y