Individual
LIBERTY REFORMA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D
Contact information
Practice address
850 HARRISON AVENUE, FL 5, YAWKEY BLDG, BOSTON, MA 02118-4001
(617) 414-2000
Mailing address
801 ALBANY STREET, FL GROUND, BOSTON, MA 02119-3791
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
278216
MA
207VM0101X
Maternal & Fetal Medicine Physician
Primary
278216
MA
Other
Enumeration date
04/12/2015
Last updated
09/08/2022
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