Provider Demographics
NPI:1952664443
Name:MOURA, LIDIA MARIA VERAS ROCHA DE (MD)
Entity Type:Individual
Prefix:DR
First Name:LIDIA MARIA
Middle Name:VERAS ROCHA DE
Last Name:MOURA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LIDIA MARIA
Other - Middle Name:
Other - Last Name:VERAS ROCHA DE MOURA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:55 FRUIT STREET
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114
Mailing Address - Country:US
Mailing Address - Phone:617-726-3311
Mailing Address - Fax:617-726-9250
Practice Address - Street 1:55 FRUIT STREET
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114
Practice Address - Country:US
Practice Address - Phone:617-726-3311
Practice Address - Fax:617-726-9250
Is Sole Proprietor?:No
Enumeration Date:2012-06-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2526152084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology