Healthcare Provider Details

I. General information

NPI: 1245956325
Provider Name (Legal Business Name): ROBERTO CIORDIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2022
Last Update Date: 10/19/2022
Certification Date: 10/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

247 PARK ST
DORCHESTER MA
02124-1334
US

IV. Provider business mailing address

247 PARK ST
DORCHESTER MA
02124-1334
US

V. Phone/Fax

Practice location:
  • Phone: 617-939-1643
  • Fax:
Mailing address:
  • Phone: 617-939-1643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084E0001X
TaxonomyEpilepsy Physician
License Number98-6859-00
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: