Individual
DR. MARA AINSLEY TIETZEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
300 LONGWOOD AVE, BOSTON, MA 02115-5724
(857) 218-4924
(617) 730-0683
Mailing address
300 LONGWOOD AVE, BOSTON, MA 02115-5724
(617) 355-6000
(617) 730-0683
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
41268
ZZ
2080S0010X
Pediatric Sports Medicine Physician
Primary
283657
MA
Other
Enumeration date
01/28/2020
Last updated
07/09/2021
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