Organization
NICOLA MOGAVERO MD FACR
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NICOLA MOGAVERO MD (OWNER)
(781) 665-9066
Entity
Organization
Contact information
Practice address
792 MAIN ST, MELROSE, MA 02176-2710
(781) 665-9066
(781) 662-9758
Mailing address
792 MAIN ST, MELROSE, MA 02176-2710
(781) 665-9066
(781) 662-9758
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
81784
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110059518A
—
MA
Enumeration date
11/04/2015
Last updated
11/04/2015
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