Maya Berdzenishvili Md LLC
Clinic/Center (Rehabilitation)

Address: 220 Commonwealth Ave Apt 4, Boston, MA 02116-2510
Phone: 6172626402

Maya Berdzenishvili Md LLC (NPI# 1477155158) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider Identifier (NPI) 1477155158
Entity Type Organization
Organization Name MAYA BERDZENISHVILI MD LLC
Practice Address 220 Commonwealth Ave Apt 4
Boston
MA 02116-2510
Practice Telephone 6172626402
Practice Fax Number 6172626402
Mailing Address 220 Commonwealth Ave Apt 4
Boston
MA 02116-2510
Mailing Telephone 6172626402
Mailing Fax Number 6172626402
Authorized Official Name Dr. Maya Berdzenishvili (OWNER)
Authorized Official Telephone 6172620462
Authorized Official Credential MD
Organization Subpart No, this organization is not a Subpart
Enumeration Date 2020-11-09
Last Update Date 2020-11-09

Taxonomy Codes

Primary Taxonomy Classification Taxonomy Group License Number State
Yes 261QR0400X Clinic/Center · Rehabilitation Ambulatory Health Care Facilities

Other Provider/Organization Names

Other Name Type Code
Maya Berdzenishvili MD LLC Other Name - Individual/Organization

Taxonomy Information

Taxonomy Code 261QR0400X
Grouping Ambulatory Health Care Facilities
Classification Clinic/Center
Specialization Rehabilitation

Taxonomy Definition

Definition to come…

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Office Location

Street Address 220 COMMONWEALTH AVE APT 4
City BOSTON
State MA
Zip Code 02116-2510

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NPI Name Taxonomy Address Enumeration
1104439272 Dennis Lau Pharmacist 21-23 Stanhope St., Boston, MA 02116 2020-08-28
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1114407467 Marissa Shallcross Social Worker 120 Boylston Street, Boston, MA 02116 2018-08-16
1245732825 Rachel Klein Social Worker 39 Boylston Street, Boston, MA 02116 2018-02-28
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1982117743 Cassandra Xanthos Social Worker Tca Counseling, 262 Beacon St. 2nd Floor, Boston, MA 02116 2017-11-14
1255859757 Carolyn Jamie Kussmaul Physician Assistant 216 Beacon Street Apt 1, Boston, MA 02116 2017-09-05
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Competitor

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City BOSTON
Zip Code 02116

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.