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NPI Code Detail

MEDICARE: RENEE AVERSANO MD

MEDICARE: RENEE AVERSANO MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician77961MA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1962402255
Entity Type Code : Individual
Provider Name (Legal Business Name) : RENEE AVERSANO MD
Provider Business Mailing Address
First Line : 521 MOUNT AUBURN ST
Second Line : STE 200
City : WATERTOWN
State : MA
Zip : 02472-4191
Country : US
Telephone Number : 617-923-6071
Fax Number : 617-923-6075
Provider Business Practice Location Address
First Line : 10 FORBES RD STE 190
Second Line :
City : BRAINTREE
State : MA
Zip : 02184-2622
Country : US
Telephone Number : 781-884-6300
Fax Number : 781-884-6305
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/28/2005
Last Update Date : 04/04/2023

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