Healthcare Provider Details

I. General information

NPI: 1205330115
Provider Name (Legal Business Name): MATTHEW PATRICK VIVERO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2018
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 FRANCIS ST
BOSTON MA
02115-6106
US

IV. Provider business mailing address

75 WALTHAM ST APT 5
BOSTON MA
02118-3622
US

V. Phone/Fax

Practice location:
  • Phone: 617-732-8181
  • Fax:
Mailing address:
  • Phone: 860-575-3891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number290150
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: