Individual provider Active NPI

Victoria Marie Derevianko, MD

  • Anesthesiology Physician
  • Boston, MA
National Provider Identifier
1699095745
Registry record updated May 29, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
273964 Issued in MA
Practice address
330 Brookline Ave Dept of
Boston, MA 02215
Phone
(617) 667-3110
NPI assigned
Jun 10, 2010
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 29, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 273964 MA Primary

Addresses

Primary practice location

330 Brookline Ave Dept of
Boston, MA 02215

Mailing address

5801 Nicholson LN
Suite # 606
Rockville, MD 20852-5719

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180228000537 MA Practitioner - Anesthesiology 4789945197 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Associated Physicians of Harvard Medical Faculty Physicians at Beth IsGroup PAC ID 6305749987, shared by 7 NPIs, 566 clinicians

Practice addresses (Care Compare)

101 Page St
New Bedford, MA 02740-3464
Phone (781) 983-9088

199 Reedsdale Rd
Milton, MA 02186-3926

25 Highland Ave
Newburyport, MA 01950-3867

Hospital & facility affiliations

  • Beth Israel Deaconess Hospital - Milton Hospital, Milton, MA, CCN 220108

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
273964MAMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Harvard Medical Faculty Phys at Beth Israel Deaconess Med Ctr Inc CurrentSince Aug 1, 2025 Accepting new patients
Associated Physicians of Harvard Medical Faculty Physicians at Beth Is Current Accepting new patients
Associated Physicians of Harvard Medical Faculty Physicians at Beth Is CurrentSince Sep 1, 2025 Accepting new patients
Harvard Medical Faculty Phys at Beth Israel Deaconess Med Ctr Inc Current Accepting new patients
Harvard Medical Faculty Phys at Beth Israel Deaconess Med Ctr Inc CurrentSince Jan 2, 2018 Accepting new patients
Beth Israel Deaconess Medical Center, Inc. CurrentSince Jan 2, 2018 Accepting new patients
Beth Israel Deaconess Medical Center, Inc. CurrentSince Jan 2, 2018 Accepting new patients
Associated Physicians of Harvard Medical Faculty Physicians at Beth Is Anesthesiology CurrentSince Jul 1, 2020 Accepting new patients
Harvard Medical Faculty Phys at Beth Israel Deaconess Med Ctr Inc Anesthesiology CurrentSince Jan 2, 2018 Accepting new patients
Associated Physicians of Harvard Medical Faculty Physicians at Beth Is CurrentSince Jul 1, 2020 Accepting new patients

Locations

330 Brookline Ave
Boston, MA 02215
Phone (617) 667-2000

101 Page St
New Bedford, MA 02740
Phone (508) 961-5425

25 Highland Ave
Newburyport, MA 01950
Phone (978) 258-4734

Interoperability endpoints

  • Direct secure messaging: vderevianko254717@direct.bilh.masshiway.net

Organizations & group practices 10

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1276128000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1527552000000",
    "number": "1699095745",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5801 NICHOLSON LN",
            "address_2": "SUITE # 606",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208525719"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 BROOKLINE AVE DEPT OF",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "02215",
            "telephone_number": "617-667-3110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEREVIANKO",
        "first_name": "VICTORIA",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-06-10",
        "last_updated": "2018-05-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "MA",
            "license": "273964",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.