Provider Demographics
NPI:1831304112
Name:RIVERA, MIGUEL N (MD)
Entity Type:Individual
Prefix:
First Name:MIGUEL
Middle Name:N
Last Name:RIVERA
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 1:17 LEE ST # T5
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-2203
Mailing Address - Country:US
Mailing Address - Phone:617-354-1903
Mailing Address - Fax:
Practice Address - Street 1:149 13TH ST
Practice Address - Street 2:BLDG 149, ROOM 7-101
Practice Address - City:CHARLESTOWN
Practice Address - State:MA
Practice Address - Zip Code:02129-2020
Practice Address - Country:US
Practice Address - Phone:617-726-5475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA223369207SM0001X, 207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207SM0001XAllopathic & Osteopathic PhysiciansMedical GeneticsMolecular Genetic Pathology
Not Answered207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology