Healthcare Provider Details

I. General information

NPI: 1073591228
Provider Name (Legal Business Name): ALVARO PASCUAL-LEONE M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 08/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 CENTRE ST
ROSLINDALE MA
02131-1000
US

IV. Provider business mailing address

375 LONGWOOD AVE HARVARD MEDICAL FACULTY ASSOCIATES - MASCO BUILDING
BOSTON MA
02215-5395
US

V. Phone/Fax

Practice location:
  • Phone: 617-363-8000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number152632
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number152632
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: