Provider Demographics
NPI:1699723551
Name:ZIBAITIS, AUDRIUS (MD)
Entity type:Individual
Prefix:DR
First Name:AUDRIUS
Middle Name:
Last Name:ZIBAITIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:55 FRUIT ST
Mailing Address - Street 2:MASSACHUSETTS GENERAL HOSPITAL, GRB 444
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114
Mailing Address - Country:US
Mailing Address - Phone:617-643-6754
Mailing Address - Fax:617-643-4040
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:MASSACHUSETTS GENERAL HOSPITAL, GRB 444
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114
Practice Address - Country:US
Practice Address - Phone:617-643-6754
Practice Address - Fax:617-643-4040
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA213297207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA200718SMedicaid
MAA35390Medicare ID - Type Unspecified
MA200718SMedicaid