Healthcare Provider Details

I. General information

NPI: 1699341180
Provider Name (Legal Business Name): DON MACHARIA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2021
Last Update Date: 08/21/2021
Certification Date: 08/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 BELMONT ST BLDG 2
BROCKTON MA
02301-5596
US

IV. Provider business mailing address

940 BELMONT ST BLDG 2
BROCKTON MA
02301-5596
US

V. Phone/Fax

Practice location:
  • Phone: 774-826-3411
  • Fax:
Mailing address:
  • Phone: 774-826-3411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN2284314
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: