Healthcare Provider Details

I. General information

NPI: 1215756366
Provider Name (Legal Business Name): MORENO FAVARATO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2024
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 BROOKLINE AVE DEPARTMENT OF ANESTHESIA
BOSTON MA
02215
US

IV. Provider business mailing address

330 BROOKLINE AVE DEPARTMENT OF ANESTHESIA
BOSTON MA
02215
US

V. Phone/Fax

Practice location:
  • Phone: 617-667-3112
  • Fax: 617-754-8791
Mailing address:
  • Phone: 617-667-3112
  • Fax: 617-754-8791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number5001507
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: