Individual
DR. JORDAN D DIMITRAKOFF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D., PH.D.
Contact information
Practice address
330 BROOKLINE AVE KS-316, BETH ISRAEL DECONESS MEDICAL CENTER, BOSTON, MA 02215
(617) 667-2051
(617) 249-2035
Mailing address
330 BROOKLINE AVE KS-316, BETH ISRAEL DECONESS MEDICAL CENTER, BOSTON, MA 02215
(617) 667-2051
(617) 249-2035
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
244988
MA
207R00000X
Internal Medicine Physician
PENDING
MA
207RA0000X
Adolescent Medicine (Internal Medicine) Physician
PENDING
MA
208800000X
Urology Physician
244988
MA
208800000X
Urology Physician
PENDING
MA
Other
Enumeration date
05/01/2009
Last updated
05/23/2011
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