# NICOLA MOGAVERO MD FACR

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1396118964
- **Authorized official:** DR. NICOLA MOGAVERO MD (OWNER)
- **Authorized official phone:** (781) 665-9066

## Contact information

- **Practice address:** 792 MAIN ST, MELROSE, MA 02176-2710
- **Practice address phone:** (781) 665-9066
- **Practice address fax:** (781) 662-9758
- **Mailing address:** 792 MAIN ST, MELROSE, MA 02176-2710
- **Mailing address phone:** (781) 665-9066
- **Mailing address fax:** (781) 662-9758

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | 81784 | MA | Yes |

## Other

- **Enumeration date:** 11/04/2015
- **Last updated:** 11/04/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 110059518A | — | MA |