Healthcare Provider Details

I. General information

NPI: 1972316081
Provider Name (Legal Business Name): VIVIAN PARASKEVI DOUGLAS MD, DVM, MBA, MSC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PARASKEVI NTAGLA

II. Dates (important events)

Enumeration Date: 01/31/2025
Last Update Date: 01/31/2025
Certification Date: 01/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 BROOKLINE AVE
BOSTON MA
02215-5403
US

IV. Provider business mailing address

300 BROOKLINE AVE
BOSTON MA
02215-5403
US

V. Phone/Fax

Practice location:
  • Phone: 617-667-3210
  • Fax:
Mailing address:
  • Phone: 617-667-3210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number-
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: