Healthcare Provider Details

I. General information

NPI: 1164050886
Provider Name (Legal Business Name): PIETRO MIOZZO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2020
Last Update Date: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 BROOKLINE AVE
BOSTON MA
02215-5450
US

IV. Provider business mailing address

450 BROOKLINE AVE
BOSTON MA
02215-5450
US

V. Phone/Fax

Practice location:
  • Phone: 617-632-3270
  • Fax: 617-632-6570
Mailing address:
  • Phone: 617-632-3270
  • Fax: 617-632-6570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number1013186
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: