Provider Demographics
NPI:1629561170
Name:AREVALO, JOHN BENJAMIN JESS (MD, MBA)
Entity Type:Individual
Prefix:DR
First Name:JOHN BENJAMIN
Middle Name:JESS
Last Name:AREVALO
Suffix:
Gender:M
Credentials:MD, MBA
Other - Prefix:DR
Other - First Name:BEN
Other - Middle Name:
Other - Last Name:AREVALO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, MBA
Mailing Address - Street 1:201 S HUNTINGTON AVE UNIT 414
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02130-5268
Mailing Address - Country:US
Mailing Address - Phone:623-205-2327
Mailing Address - Fax:
Practice Address - Street 1:75 FRANCIS ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-6106
Practice Address - Country:US
Practice Address - Phone:617-732-5500
Practice Address - Fax:888-755-4574
Is Sole Proprietor?:No
Enumeration Date:2018-06-10
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1015248208VP0014X, 207PH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207PH0002XAllopathic & Osteopathic PhysiciansEmergency MedicineHospice and Palliative Medicine