Provider Demographics
NPI:1760571087
Name:VERA, JUAN C (MD)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:C
Last Name:VERA
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 1:212 ASHMONT ST
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER CENTER
Mailing Address - State:MA
Mailing Address - Zip Code:02124-3802
Mailing Address - Country:US
Mailing Address - Phone:618-825-7333
Mailing Address - Fax:617-738-1450
Practice Address - Street 1:212 ASHMONT ST
Practice Address - Street 2:
Practice Address - City:DORCHESTER CENTER
Practice Address - State:MA
Practice Address - Zip Code:02124-3802
Practice Address - Country:US
Practice Address - Phone:618-825-7333
Practice Address - Fax:617-738-1450
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA42125261QX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0102458Medicaid
MAD83040Medicare UPIN
MA0102458Medicaid