Provider Demographics
NPI:1184646747
Name:MOTTA, MARIO E (MD)
Entity Type:Individual
Prefix:
First Name:MARIO
Middle Name:E
Last Name:MOTTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 ELECTRONICS AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-1099
Mailing Address - Country:US
Mailing Address - Phone:978-750-0300
Mailing Address - Fax:978-279-1324
Practice Address - Street 1:3 ELECTRONICS AVE STE 201
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-1099
Practice Address - Country:US
Practice Address - Phone:978-750-0300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA44673207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3021807Medicaid
MA3021807Medicaid
MAA54165Medicare UPIN