Provider Demographics
NPI:1598707994
Name:VIVES, PATRICIO FERNANDEZ (MD)
Entity Type:Individual
Prefix:
First Name:PATRICIO
Middle Name:FERNANDEZ
Last Name:VIVES
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 1:25 BOYLSTON ST
Mailing Address - Street 2:SUITE 112
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467-1715
Mailing Address - Country:US
Mailing Address - Phone:617-277-2541
Mailing Address - Fax:
Practice Address - Street 1:25 BOYLSTON ST
Practice Address - Street 2:SUITE 112
Practice Address - City:CHESTNUT HILL
Practice Address - State:MA
Practice Address - Zip Code:02467-1715
Practice Address - Country:US
Practice Address - Phone:617-277-2541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-11
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA379712080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2033518Medicaid
D88128Medicare UPIN