Healthcare Provider Details

I. General information

NPI: 1538687827
Provider Name (Legal Business Name): MARISSA S AARON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2017
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 LONGWOOD AVE
BOSTON MA
02115-5711
US

IV. Provider business mailing address

333 LONGWOOD AVE
BOSTON MA
02115-5711
US

V. Phone/Fax

Practice location:
  • Phone: 617-355-7476
  • Fax: 617-730-0194
Mailing address:
  • Phone: 617-355-7476
  • Fax: 617-730-0194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number1018771
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: