Provider Demographics
NPI:1417558222
Name:EYZAGUIRRE PELLON, MARIA TERESA ALEJANDRA (MB BCH BAO, MSC)
Entity Type:Individual
Prefix:DR
First Name:MARIA TERESA
Middle Name:ALEJANDRA
Last Name:EYZAGUIRRE PELLON
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Gender:F
Credentials:MB BCH BAO, MSC
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Mailing Address - Street 1:800 WASHINGTON STREET
Mailing Address - Street 2:ZISKIND 5
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111
Mailing Address - Country:US
Mailing Address - Phone:617-363-5829
Mailing Address - Fax:
Practice Address - Street 1:800 WASHINGTON STREET
Practice Address - Street 2:ZISKIND 5
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111
Practice Address - Country:US
Practice Address - Phone:617-363-5829
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MAETLL-342207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology