Provider Demographics
NPI:1871052985
Name:GJINI, PETRO (MD)
Entity type:Individual
Prefix:
First Name:PETRO
Middle Name:
Last Name:GJINI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:PETRIKA
Other - Middle Name:
Other - Last Name:GJINI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:725 ALBANY ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2526
Mailing Address - Country:US
Mailing Address - Phone:617-414-5951
Mailing Address - Fax:
Practice Address - Street 1:732 HARRISON AVENUE, FL 3
Practice Address - Street 2:PRESTON BLDG
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2309
Practice Address - Country:US
Practice Address - Phone:617-638-7490
Practice Address - Fax:617-414-8742
Is Sole Proprietor?:No
Enumeration Date:2019-03-18
Last Update Date:2025-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MA1022521207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine