Healthcare Provider Details

I. General information

NPI: 1265882591
Provider Name (Legal Business Name): JOSEPH ANTHONY CERASUOLO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2016
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 WASHINGTON ST
BOSTON MA
02111-1552
US

IV. Provider business mailing address

800 WASHINGTON ST PO BOX #298
BOSTON MA
02111
US

V. Phone/Fax

Practice location:
  • Phone: 617-636-6044
  • Fax:
Mailing address:
  • Phone: 617-636-6044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number266996
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: