Provider Demographics
NPI:1518935063
Name:DE VERA, MARIA T (DO)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:T
Last Name:DE VERA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 847348
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02284-7348
Mailing Address - Country:US
Mailing Address - Phone:508-823-2762
Mailing Address - Fax:508-828-6886
Practice Address - Street 1:72 WASHINGTON ST
Practice Address - Street 2:SUITE 2100
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-2491
Practice Address - Country:US
Practice Address - Phone:508-823-2762
Practice Address - Fax:508-828-6886
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA219962207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2090881Medicaid
MA2090881Medicaid
I12701Medicare UPIN