Individual
MAMUKA GVENTSADZE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
6 PARKWAY RD, BROOKLINE, MA 02445-5463
(617) 416-4203
Mailing address
6 PARKWAY RD, BROOKLINE, MA 02445-5463
(617) 416-4203
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
3017581
MA
Other
Enumeration date
01/28/2025
Last updated
01/28/2025
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