Active NPI
Liran Domachevsky
- Nuclear Radiology Physician
- Brookline, MA
National Provider Identifier
1487909412
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nuclear Radiology Physician
- License
- 248431
- Practice address
- 375 Boylston St
Brookline, MA 02445-6007 - Phone
- (857) 307-0849
- NPI assigned
- Jul 16, 2012
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nuclear Radiology Physician | 2085N0904X | 248431 | MA | Primary |
Addresses
Primary practice location
375 Boylston St
Brookline, MA 02445-6007
Mailing address
29 Bartlett Crescent Apt 2
Brookline, MA 02446
Phone (617) 529-2093
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 248431 | MA | MD | Nuclear Radiology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1342396800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1342396800000",
"number": "1487909412",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "29 BARTLETT CRESCENT APT 2",
"city": "BROOKLINE",
"state": "MA",
"postal_code": "02446",
"telephone_number": "617-529-2093"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "375 BOYLSTON ST",
"city": "BROOKLINE",
"state": "MA",
"postal_code": "024456007",
"telephone_number": "857-307-0849"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOMACHEVSKY",
"first_name": "LIRAN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-07-16",
"last_updated": "2012-07-16",
"status": "A"
},
"taxonomies": [
{
"code": "2085N0904X",
"taxonomy_group": "",
"desc": "Radiology, Nuclear Radiology",
"state": "MA",
"license": "248431",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brookline, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.