Healthcare Provider Details

I. General information

NPI: 1184039869
Provider Name (Legal Business Name): MARIANELLA PAZ-LANSBERG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIANELLA PAZ SILVA M.D

II. Dates (important events)

Enumeration Date: 06/22/2014
Last Update Date: 12/22/2021
Certification Date: 12/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 HARRISON AVE STE 400
BOSTON MA
02118-2905
US

IV. Provider business mailing address

800 HARRISON AVE FL BCD5
BOSTON MA
02118-2905
US

V. Phone/Fax

Practice location:
  • Phone: 617-638-8124
  • Fax: 617-414-4953
Mailing address:
  • Phone: 617-638-7934
  • Fax: 617-638-7965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number125065544
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number289543
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: