Provider Demographics
NPI:1366683997
Name:BESERRA, FREDERICO CALVET (MD)
Entity Type:Individual
Prefix:
First Name:FREDERICO
Middle Name:CALVET
Last Name:BESERRA
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 1:119 THOREAU WAY
Mailing Address - Street 2:APT 633
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01843-3911
Mailing Address - Country:US
Mailing Address - Phone:401-456-2179
Mailing Address - Fax:
Practice Address - Street 1:119 THOREAU WAY
Practice Address - Street 2:APT 633
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01843-3911
Practice Address - Country:US
Practice Address - Phone:401-456-2179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-11
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA241942207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine