Individual
PATRICK E TIVNAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
300 LONGWOOD AVE, BOSTON, MA 02115-5724
(617) 355-6000
Mailing address
300 LONGWOOD AVE, BOSTON, MA 02115-5724
(617) 355-6000
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
271287
MA
2085R0202X
Diagnostic Radiology Physician
271287
MA
2085R0202X
Diagnostic Radiology Physician
Primary
D96423
MD
Other
Enumeration date
06/08/2017
Last updated
05/13/2025
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