Individual
EZRA MARGONO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
55 FRUIT ST, BOSTON, MA 02114-2621
(617) 643-7860
Mailing address
820 HARRISON AVE BLDG 4TH, BOSTON, MA 02118-2905
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
1018248
MA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/12/2019
Last updated
04/29/2024
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