Healthcare Provider Details

I. General information

NPI: 1609224682
Provider Name (Legal Business Name): MARIA BORRELLI D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2016
Last Update Date: 06/20/2023
Certification Date: 06/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 BROOKLINE AVE DEPT OF
BOSTON MA
02215-5400
US

IV. Provider business mailing address

330 BROOKLINE AVE DEPT OF
BOSTON MA
02215-5400
US

V. Phone/Fax

Practice location:
  • Phone: 617-667-3110
  • Fax: 617-754-8791
Mailing address:
  • Phone: 617-667-3110
  • Fax: 617-754-8791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number286596
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: