Individual
MARCO LOI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1440 MAIN ST, WALTHAM, MA 02451-1631
(781) 891-9300
(781) 891-9305
Mailing address
PO BOX 1849, LEWISTON, ME 04241-1849
(207) 784-2554
(207) 777-5363
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN274270
MA
Other
Enumeration date
04/10/2012
Last updated
01/23/2014
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