Healthcare Provider Details

I. General information

NPI: 1831304112
Provider Name (Legal Business Name): MIGUEL N RIVERA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

149 13TH ST BLDG 149, ROOM 7-101
CHARLESTOWN MA
02129-2020
US

IV. Provider business mailing address

17 LEE ST # T5
CAMBRIDGE MA
02139-2203
US

V. Phone/Fax

Practice location:
  • Phone: 617-726-5475
  • Fax:
Mailing address:
  • Phone: 617-354-1903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207SM0001X
TaxonomyMolecular Genetic Pathology (Medical Genetics) Physician
License Number223369
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number223369
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: