Individual
DR. MAURIZIO FAVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
55 FRUIT ST, BULFINCH 351, MASSACHUSETTS GENERAL HOSPITAL, BOSTON, MA 02114
(617) 724-0838
(617) 726-2688
Mailing address
55 FRUIT ST, BULFINCH 351, MASSACHUSETTS GENERAL HOSPITAL, BOSTON, MA 02114
(617) 724-0838
(617) 726-2688
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
59460
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
724726
TUFTS HEALTH PLAN
MA
01
—
J14644
BCBS MA
MA
Enumeration date
02/02/2006
Last updated
09/21/2018
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