Provider Demographics
NPI:1912400219
Name:OLIVEIRA, MARCELO ANTONIO (CRNA)
Entity Type:Individual
Prefix:
First Name:MARCELO
Middle Name:ANTONIO
Last Name:OLIVEIRA
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:MARCELO
Other - Middle Name:ANTONIO MIRANDA
Other - Last Name:OLIVEIRA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNA
Mailing Address - Street 1:11 FAIRBANKS RD
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01701-7911
Mailing Address - Country:US
Mailing Address - Phone:508-733-1805
Mailing Address - Fax:
Practice Address - Street 1:115 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-6358
Practice Address - Country:US
Practice Address - Phone:508-383-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-13
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN271760367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered