Provider Demographics
NPI:1013513621
Name:NOGAROTTO, VIVIANE I
Entity Type:Individual
Prefix:DR
First Name:VIVIANE
Middle Name:
Last Name:NOGAROTTO
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 COACHLACE ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MA
Mailing Address - Zip Code:01510-2407
Mailing Address - Country:US
Mailing Address - Phone:978-808-0444
Mailing Address - Fax:
Practice Address - Street 1:413 PARADISE RD
Practice Address - Street 2:
Practice Address - City:SWAMPSCOTT
Practice Address - State:MA
Practice Address - Zip Code:01907-1332
Practice Address - Country:US
Practice Address - Phone:781-595-8588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-09
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH2328651835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0Medicaid