Individual
MARK A FAVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1101 BEACON STREET, SUITE 6 WEST, BROOKLINE, MA 02446
(617) 566-0062
Mailing address
1101 BEACON STREET, SUITE 6 WEST, BROOKLINE, MA 02446
(617) 566-0062
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
237987
MA
Other
Enumeration date
08/15/2008
Last updated
08/15/2008
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