# MAYA BERDZENISHVILI MD LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Maya Berdzenishvili MD LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1477155158
- **Authorized official:** DR. MAYA BERDZENISHVILI MD (OWNER)
- **Authorized official phone:** (617) 262-0462

## Contact information

- **Practice address:** 220 COMMONWEALTH AVE APT 4, BOSTON, MA 02116-2510
- **Practice address phone:** (617) 262-6402
- **Practice address fax:** (617) 262-6402
- **Mailing address:** 220 COMMONWEALTH AVE APT 4, BOSTON, MA 02116-2510
- **Mailing address phone:** (617) 262-6402
- **Mailing address fax:** (617) 262-6402

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RP1001X | Pulmonary Disease Physician | — | NULL | Yes |
| 207RP1001X | Pulmonary Disease Physician | — | — | Yes |
| 261QR0400X | Rehabilitation Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 11/09/2020
- **Last updated:** 02/19/2024