Provider Demographics
NPI:1609853100
Name:RIOS, JORGE (MD)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:
Last Name:RIOS
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 1:180 RUSTCRAFT RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02026-4558
Mailing Address - Country:US
Mailing Address - Phone:781-461-2231
Mailing Address - Fax:781-461-2020
Practice Address - Street 1:180 RUSTCRAFT RD
Practice Address - Street 2:
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026-4551
Practice Address - Country:US
Practice Address - Phone:781-461-2221
Practice Address - Fax:781-461-2020
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA212155207ZB0001X, 207ZP0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZB0001XAllopathic & Osteopathic PhysiciansPathologyBlood Banking & Transfusion Medicine
No207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine