Provider Demographics
NPI:1295249712
Name:FABIANA LUCIA DA SILVA, ANNACAROLINA (MD)
Entity type:Individual
Prefix:
First Name:ANNACAROLINA
Middle Name:
Last Name:FABIANA LUCIA DA SILVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ANNACAROLINA
Other - Middle Name:
Other - Last Name:DA SILVA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:44 WASHINGTON ST APT 1215A
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-7106
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:75 FRANCIS STREET
Practice Address - Street 2:AMORY BUILDING, PATHOLOGY DEPARTMENT
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215
Practice Address - Country:US
Practice Address - Phone:617-732-8613
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-20
Last Update Date:2017-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA271266207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAS34863401OtherCOMMONWEALTH OF MASSACHUSETTS