Provider Demographics
NPI:1730179110
Name:DIPIRO, PAMELA JEAN (MD)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:JEAN
Last Name:DIPIRO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 FRANCIS ST
Mailing Address - Street 2:BRIGHAM & WOMEN'S HOSPITAL, RADIOLOGY
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-6110
Mailing Address - Country:US
Mailing Address - Phone:617-632-3218
Mailing Address - Fax:617-525-7333
Practice Address - Street 1:44 BINNEY ST
Practice Address - Street 2:DANA FARBER CANCER INSTITUTE
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-6013
Practice Address - Country:US
Practice Address - Phone:617-632-3218
Practice Address - Fax:617-525-7333
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA772582085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ13745OtherBLUE CROSS/BLUE SHIELD
MA739495OtherTUFTS
MA3108457Medicaid
MAJ13745Medicare ID - Type Unspecified
MA3108457Medicaid