Provider Demographics
NPI:1649259060
Name:CRUZ-GERVIS, ROBERTO ANTONIO (MD)
Entity type:Individual
Prefix:
First Name:ROBERTO
Middle Name:ANTONIO
Last Name:CRUZ-GERVIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ROBERTO
Other - Middle Name:ANTONIO
Other - Last Name:CRUZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:132 ARLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467-2617
Mailing Address - Country:US
Mailing Address - Phone:617-754-6199
Mailing Address - Fax:617-754-5938
Practice Address - Street 1:125 PARKER HILL AVE STE 502
Practice Address - Street 2:
Practice Address - City:ROXBURY CROSSING
Practice Address - State:MA
Practice Address - Zip Code:02120-2847
Practice Address - Country:US
Practice Address - Phone:617-754-6199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA220900207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2078198Medicaid
MA2078198Medicaid
H03990Medicare UPIN