Individual
DR. GENNADIY FUZAYLOV
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
55 FRUIT ST, CLN 309, BOSTON, MA 02114-2696
(617) 726-3030
(617) 726-7536
Mailing address
PO BOX 9142, CHARLESTOWN, MA 02129-9142
(617) 724-0287
(617) 726-2894
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
210490
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0180394
—
MA
01
—
210490
TUFTS HEALTH PLAN
MA
01
—
J25410
BCBS MA
MA
Enumeration date
10/31/2005
Last updated
07/08/2007
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