Individual
PETER M. REVENO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1153 CENTRE ST, RADIOLOGY, FAULKNER HOSPITAL, BOSTON, MA 02130-3446
(617) 983-7090
(617) 983-7091
Mailing address
1153 CENTRE ST, RADIOLOGY, FAULKNER HOSPITAL, BOSTON, MA 02130-3446
(617) 983-7090
(617) 983-7091
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
31950
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3134792
—
MA
01
—
713987
TUFTS HEALTH CARE
MA
01
—
D05045
BLUE CROSS/BLUE SHIELD
MA
Enumeration date
09/29/2005
Last updated
08/10/2007
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