Provider Demographics
NPI:1598746356
Name:TESTA, ENRIQUE (MD)
Entity Type:Individual
Prefix:
First Name:ENRIQUE
Middle Name:
Last Name:TESTA
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 1:226 HARVARD AVE
Mailing Address - Street 2:THIRD FLOOR
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02134-4605
Mailing Address - Country:US
Mailing Address - Phone:617-734-7665
Mailing Address - Fax:617-277-7311
Practice Address - Street 1:226 HARVARD AVE
Practice Address - Street 2:THIRD FLOOR
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02134-4605
Practice Address - Country:US
Practice Address - Phone:617-734-7665
Practice Address - Fax:617-277-7311
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA43177207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0105724Medicaid
B95251Medicare UPIN
MAC04859Medicare ID - Type Unspecified