Healthcare Provider Details

I. General information

NPI: 1720477516
Provider Name (Legal Business Name): PIETRO BORTOLETTO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2015
Last Update Date: 01/29/2026
Certification Date: 01/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 STERGIS WAY
DEDHAM MA
02026-2637
US

IV. Provider business mailing address

45 STERGIS WAY
DEDHAM MA
02026-2637
US

V. Phone/Fax

Practice location:
  • Phone: 781-675-3192
  • Fax: 781-747-6754
Mailing address:
  • Phone: 781-675-3192
  • Fax: 781-747-6754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number291664
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: