Gvantsa Didebulidze, MD
Internal Medicine in Brockton, Massachusetts
1730474644- Practice location
- 63 Main St, Brockton, MA 02301-4042
- Phone
- 508-559-6699
- Fax
- 508-559-5073
- Last updated
- May 19, 2025
Gvantsa Didebulidze is an Internal Medicine based in Brockton, MA. Gvantsa Didebulidze practices in Brockton, MA and has the professional credentials of MD. The NPI Number for Gvantsa Didebulidze is 1730474644 and holds a License No. 257775 (MA). The current practice location address for Gvantsa Didebulidze is 63 Main St, Brockton, MA 02301-4042 and can be reached out via phone at 508-559-6699 and via fax at 508-559-5073.
Provider Profile Details
- NPI Number
- 1730474644
- Provider Name
- Gvantsa Didebulidze
- Credential
- MD
- Provider Entity Type
- Individual
- Gender
- Female
- Address
- 63 Main St, Brockton, MA 02301-4042
- Phone Number
- 508-559-6699
- Fax Number
- 508-559-5073
- Primary Taxonomy
- Internal Medicine · 207R00000X
- Sole Proprietor
- No
- Provider Enumeration Date
- June 20, 2011
- Last Update Date
- May 19, 2025
- Certification Date
- May 19, 2025
- NPI Status
- Active
Provider Business Practice Location Address Details
- Address
- 63 Main St
Brockton, MA 02301-4042 - City
- Brockton
- State
- Massachusetts
- Zip
- 02301-4042
- Phone Number
- 508-559-6699
- Fax Number
- 508-559-5073
Provider Business Mailing Address Details
- Address
- 63 Main St
Brockton, MA 02301-4042 - City
- Brockton
- State
- MA
- Zip
- 02301-4042
- Phone Number
- 508-559-6699
- Fax Number
- 508-559-5073
License Information
- License Number
- 257775
- License State
- MA
- Taxonomy
- Internal Medicine · 207R00000X · Primary
Legacy Identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| No legacy identifiers (Medicaid, Medicare or plan IDs) are on file for this provider. | |||
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Frequently Asked Questions
What is the NPI number of Gvantsa Didebulidze, MD?
The NPI number of Gvantsa Didebulidze, MD is 1730474644. It was assigned on June 20, 2011 and is currently active in the NPPES registry.
What is the specialty of Gvantsa Didebulidze, MD?
Gvantsa Didebulidze, MD is registered under the primary taxonomy Internal Medicine (code 207R00000X), licensed in MA under license number 257775.
Where does Gvantsa Didebulidze, MD practice?
The practice location is 63 Main St, Brockton, MA 02301-4042. The office can be reached at 508-559-6699 (phone) or 508-559-5073 (fax).
What is an NPI number?
A National Provider Identifier (NPI) is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS). It is used in HIPAA standard transactions.
How do I verify this NPI record?
This record is sourced from the public NPPES NPI Registry maintained by CMS. You can confirm it by searching NPI 1730474644 directly on the NPPES registry website.