Healthcare Provider Details

I. General information

NPI: 1912400219
Provider Name (Legal Business Name): MARCELO ANTONIO OLIVEIRA CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MARCELO ANTONIO MIRANDA OLIVEIRA CRNA

II. Dates (important events)

Enumeration Date: 03/13/2018
Last Update Date: 03/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 LINCOLN ST
FRAMINGHAM MA
01702-6358
US

IV. Provider business mailing address

11 FAIRBANKS RD
FRAMINGHAM MA
01701-7911
US

V. Phone/Fax

Practice location:
  • Phone: 508-383-1000
  • Fax:
Mailing address:
  • Phone: 508-733-1805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN271760
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: