Basic Information
| Provider Information | |||||||||
| NPI: | 1396730396 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FERZOCO | ||||||||
| FirstName: | VICTOR | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 111 CYPRESS ST | ||||||||
| Address2: | |||||||||
| City: | BROOKLINE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024456002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8573070896 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1337 HYDE PARK AVE | ||||||||
| Address2: | C/O HYDE PARK MEDICAL CARE | ||||||||
| City: | HYDE PARK | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021362713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6173649880 | ||||||||
| FaxNumber: | 6173613663 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2005 | ||||||||
| LastUpdateDate: | 07/06/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 78147 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 68634 | 01 | HARVARD PILGRIM HEALTHCAR | OTHER | 772067 | 01 | MA | TUFTS | OTHER | 0401505 | 01 | UNITED HEALTHCARE | OTHER | 110151320 | 01 | PALMETTO GBA RAILROAD MED | OTHER | 813110 | 01 | AETNA US HEALTHCARE | OTHER | 043235613 | 01 | TAX ID GROUP BILLING NUMB | OTHER | 3169758 | 05 | MA | MEDICAID | 0011043 | 01 | NEIGHBORHOOD HEALTH PLAN | OTHER | FEJ17846 | 01 | MA | BXBS | OTHER |