Provider Demographics
NPI:1093166779
Name:DEZUBE, AARON RICHARD (MD)
Entity type:Individual
Prefix:DR
First Name:AARON
Middle Name:RICHARD
Last Name:DEZUBE
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Gender:
Credentials:MD
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Mailing Address - Street 1:960 MASSACHUSETTS AVENUE
Mailing Address - Street 2:FL 2
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2690
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11 NEVINS ST
Practice Address - Street 2:SUITE 201
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135
Practice Address - Country:US
Practice Address - Phone:617-789-2442
Practice Address - Fax:617-202-4349
Is Sole Proprietor?:No
Enumeration Date:2016-06-23
Last Update Date:2025-03-10
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Provider Licenses
StateLicense IDTaxonomies
MA279657208600000X
MA268379208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110150149AMedicaid