Provider Demographics
NPI:1487699245
Name:TALALAYEVSKY, GREGORY (MD PC)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:
Last Name:TALALAYEVSKY
Suffix:
Gender:M
Credentials:MD PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1272 HYDE PARK AVE NUM 74
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:MA
Mailing Address - Zip Code:02136-2702
Mailing Address - Country:US
Mailing Address - Phone:617-364-6221
Mailing Address - Fax:617-272-3640
Practice Address - Street 1:1272-74 HYDE PARK AVE
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:MA
Practice Address - Zip Code:02136-2702
Practice Address - Country:US
Practice Address - Phone:617-364-6221
Practice Address - Fax:617-364-7661
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2017-09-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA51654207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAA56820Medicare UPIN
MAJ02713Medicare ID - Type Unspecified
MAJ02713Medicare ID - Type Unspecified