Provider Demographics
NPI:1255307229
Name:RIVERA-OKTEM, MILAGROS (MD)
Entity Type:Individual
Prefix:
First Name:MILAGROS
Middle Name:
Last Name:RIVERA-OKTEM
Suffix:
Gender:F
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:PO BOX 3177
Mailing Address - Street 2:
Mailing Address - City:WAQUORT
Mailing Address - State:MA
Mailing Address - Zip Code:02536
Mailing Address - Country:US
Mailing Address - Phone:508-477-1304
Mailing Address - Fax:
Practice Address - Street 1:60 HODGES AVE EXT
Practice Address - Street 2:
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780
Practice Address - Country:US
Practice Address - Phone:508-977-3000
Practice Address - Fax:508-977-3208
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA295492084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
Y02045Medicare ID - Type Unspecified
B99489Medicare UPIN