Healthcare Provider Details

I. General information

NPI: 1184073975
Provider Name (Legal Business Name): SAMANTHA RIVARD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2016
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 ALBANY STREET, SUITE 6B SHAPIRO BLDG.
BOSTON MA
02118
US

IV. Provider business mailing address

960 MASSACHUSETTS AVENUE FL 2
BOSTON MA
02118-2690
US

V. Phone/Fax

Practice location:
  • Phone: 617-414-8054
  • Fax: 617-414-8055
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number1020656
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number1020656
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: