Provider Demographics
NPI:1811206899
Name:DEOLIVEIRA, SEVERINO JR
Entity Type:Individual
Prefix:MR
First Name:SEVERINO
Middle Name:
Last Name:DEOLIVEIRA
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 RIVET ST
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02744-2622
Mailing Address - Country:US
Mailing Address - Phone:508-496-2073
Mailing Address - Fax:
Practice Address - Street 1:1 RIVET ST
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02744-2622
Practice Address - Country:US
Practice Address - Phone:508-496-2073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-24
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program