Provider Demographics
NPI:1528174398
Name:ZOLOTNITSKIY, LEONID GRIGORIEVICH (MD)
Entity type:Individual
Prefix:MR
First Name:LEONID
Middle Name:GRIGORIEVICH
Last Name:ZOLOTNITSKIY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:20 ADMINISTRATION RD
Mailing Address - Street 2:BRIDGEWATER STATE HOSPITAL
Mailing Address - City:BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02324
Mailing Address - Country:US
Mailing Address - Phone:508-279-4500
Mailing Address - Fax:
Practice Address - Street 1:20 ADMINISTRATION RD
Practice Address - Street 2:BRIDGEWATER STATE HOSPITAL
Practice Address - City:BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02324
Practice Address - Country:US
Practice Address - Phone:508-279-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2277602084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2128543Medicaid
MAA40427OtherMEDICARE ID
BZ9535420OtherDEA
MAI20671Medicare UPIN