Healthcare Provider Details

I. General information

NPI: 1790462406
Provider Name (Legal Business Name): JUAN PABLO SCARANO PEREIRA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2023
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

732 HARRISON AVE
BOSTON MA
02118-2365
US

IV. Provider business mailing address

732 HARRISON AVE
BOSTON MA
02118-2365
US

V. Phone/Fax

Practice location:
  • Phone: 617-414-5634
  • Fax: 617-638-7221
Mailing address:
  • Phone: 617-414-5634
  • Fax: 617-638-7221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number3019854
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: