Healthcare Provider Details

I. General information

NPI: 1710770318
Provider Name (Legal Business Name): MAURICIO FERNANDES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 MT AUBURN ST
CAMBRIDGE MA
02138
US

IV. Provider business mailing address

330 MOUNT AUBURN STREET MEDICINE DEPARTMENT
CAMBRIDGE MA
02138
US

V. Phone/Fax

Practice location:
  • Phone: 617-499-5571
  • Fax: 617-499-5593
Mailing address:
  • Phone: 617-492-3500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number3018314
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: