Individual
IDA P GORENBURG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
230 WORCESTER ST, INTERNAL MEDICINE, WELLESLEY, MA 02481-5420
(781) 431-5220
(781) 431-5526
Mailing address
147 MILK ST, PROVIDER ENROLLMENT - 9TH FLOOR, BOSTON, MA 02109-4806
(617) 559-8374
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
220258
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2064090
—
MA
01
—
469328
TUFTS
MA
01
—
AA12995
HARVARD PILGRIM
MA
01
—
J27748
BLUE CROSS
MA
Enumeration date
02/17/2006
Last updated
10/14/2020
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