Healthcare Provider Details

I. General information

NPI: 1467242834
Provider Name (Legal Business Name): MARCOS ELI RIVERA NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2025
Last Update Date: 07/21/2025
Certification Date: 07/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 CITY HALL MALL
MEDFORD MA
02155-4754
US

IV. Provider business mailing address

290 MISHAWUM RD UNIT 4047
WOBURN MA
01801-2275
US

V. Phone/Fax

Practice location:
  • Phone: 781-306-5100
  • Fax:
Mailing address:
  • Phone: 787-478-5786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberRN2390102
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2390102
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: