Healthcare Provider Details

I. General information

NPI: 1093166779
Provider Name (Legal Business Name): AARON RICHARD DEZUBE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2016
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 NEVINS ST SUITE 201
BRIGHTON MA
02135
US

IV. Provider business mailing address

960 MASSACHUSETTS AVENUE FL 2
BRIGHTON MA
02118-2690
US

V. Phone/Fax

Practice location:
  • Phone: 617-789-2442
  • Fax: 617-202-4349
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number279657
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberMT233245
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: