Provider Demographics
NPI:1689655714
Name:ZIBRAK, JOSEPH DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:DAVID
Last Name:ZIBRAK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:20 DWIGHT ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-3609
Mailing Address - Country:US
Mailing Address - Phone:617-667-5864
Mailing Address - Fax:617-667-4849
Practice Address - Street 1:330 BROOKLINE AVE
Practice Address - Street 2:BETH ISRAEL DEACONESS MEDICAL CENTER
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5400
Practice Address - Country:US
Practice Address - Phone:617-667-5864
Practice Address - Fax:617-667-4849
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA45952207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAE05827Medicaid
MAE05827Medicaid
MAA54920Medicare UPIN