=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790175321
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRIAN M CERVONI ROSARIO MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/03/2015
-----------------------------------------------------
Last Update Date | 08/20/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 736 CAMBRIDGE ST 9TH FL
-----------------------------------------------------
City | BRIGHTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02135
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-779-6500
-----------------------------------------------------
Fax | 617-779-6785
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 960 MASSACHUSETTS AVE STE 2
-----------------------------------------------------
City | BOSTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02118-2690
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2081S0010X
-----------------------------------------------------
Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
-----------------------------------------------------
License Number | 1024384
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2081S0010X
-----------------------------------------------------
Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
-----------------------------------------------------
License Number | 023730
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 208100000X
-----------------------------------------------------
Taxonomy Name | Physical Medicine & Rehabilitation Physician
-----------------------------------------------------
License Number | 1024384
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------