Healthcare Provider Details

I. General information

NPI: 1598746356
Provider Name (Legal Business Name): ENRIQUE TESTA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 01/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 HARVARD AVE THIRD FLOOR
BOSTON MA
02134-4605
US

IV. Provider business mailing address

226 HARVARD AVE THIRD FLOOR
BOSTON MA
02134-4605
US

V. Phone/Fax

Practice location:
  • Phone: 617-734-7665
  • Fax: 617-277-7311
Mailing address:
  • Phone: 617-734-7665
  • Fax: 617-277-7311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number43177
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: