Provider Demographics
NPI:1992952055
Name:DZIALO PHYSIATRY CONSULTING PLLC
Entity type:Organization
Organization Name:DZIALO PHYSIATRY CONSULTING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ANN FRANCINE
Authorized Official - Middle Name:
Authorized Official - Last Name:DZIALO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-302-8855
Mailing Address - Street 1:P.O. BOX 129
Mailing Address - Street 2:
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-0229
Mailing Address - Country:US
Mailing Address - Phone:978-762-4888
Mailing Address - Fax:978-762-3922
Practice Address - Street 1:1515 COMMONWEALTH AVE.
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-3617
Practice Address - Country:US
Practice Address - Phone:617-254-1100
Practice Address - Fax:617-783-1813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-20
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA212681208100000X
208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0156841Medicaid
MAH54273Medicare UPIN
MA0156841Medicaid