Provider Demographics
NPI:1811988488
Name:ABRACZINSKAS, DIANE RENEE (MD)
Entity type:Individual
Prefix:DR
First Name:DIANE
Middle Name:RENEE
Last Name:ABRACZINSKAS
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Gender:F
Credentials:MD
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Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-0287
Mailing Address - Fax:617-726-2894
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:BLK 4 GASTROENTEROLOGY ASSOCIATES
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:617-724-6044
Practice Address - Fax:617-724-6832
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-02
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MA157389207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3197751Medicaid
MA157389OtherTUFTS HEALTH PLAN
MAJ21513OtherBCBS MA
G98869Medicare UPIN
MA157389OtherTUFTS HEALTH PLAN