MEDICARE: DR. RONALD F DIXON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	209179	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	J23497	OTHER	MA	BCBS MA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	209179	OTHER	MA	TUFTS HEALTH PLAN

General Provider Information

NPI Number	:	1144204447
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RONALD F DIXON MD

Provider Business Mailing Address
First Line	:	PO BOX 9142
Second Line	:	MASS GENERAL PHYSICIAN ORGANIZATION
City	:	CHARLESTOWN
State	:	MA
Zip	:	02129-9142
Country	:	US
Telephone Number	:	617-724-4900
Fax Number	:	617-228-6306

Provider Business Practice Location Address
First Line	:	165 CAMBRIDGE ST
Second Line	:	MGH BEACON HILL SUITE 501
City	:	BOSTON
State	:	MA
Zip	:	02114-2783
Country	:	US
Telephone Number	:	617-726-4900
Fax Number	:	617-228-6306

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/01/2005
Last Update Date	:	02/11/2014

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