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General NPI Number Information
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NPI Number | 1760440796
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Entity Type | Individual
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Provider Name | ALFREDO R MARTIJA M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/01/2006
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Last Update Date | 03/15/2016
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Provider Practice Location Address
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Address Line | 2100 DORCHESTER AVE
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City | BOSTON
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State | MA
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Zip | 02124-5615
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Country | US
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Telephone | 857-891-1128
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Fax | 844-365-7165
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Provider Business Mailing Address
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Address Line | 8 MUSEUM WAY UNIT 2302
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City | CAMBRIDGE
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State | MA
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Zip | 02141-1887
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Country | US
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Telephone | 857-891-1128
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Fax | 844-365-7165
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 205294
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License Number State | MA
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