Provider Demographics
NPI:1497880207
Name:GUARDINO, ERIC ENRICO (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:ENRICO
Last Name:GUARDINO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:16 CLARKE ST
Mailing Address - Street 2:UNIT B4
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-4988
Mailing Address - Country:US
Mailing Address - Phone:781-863-6053
Mailing Address - Fax:781-862-7565
Practice Address - Street 1:16 CLARKE ST
Practice Address - Street 2:UNIT B4
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02421-4988
Practice Address - Country:US
Practice Address - Phone:781-863-6053
Practice Address - Fax:781-862-7565
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA57734207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3034895Medicaid
MAA66549Medicare UPIN
MAJ07080Medicare PIN