Provider Demographics
NPI:1720838733
Name:DE BARROS WANDERLEY JUNIOR, MAURO ROGERIO (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:MAURO ROGERIO
Middle Name:
Last Name:DE BARROS WANDERLEY JUNIOR
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 STEARNS RD APT 502
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-5134
Mailing Address - Country:US
Mailing Address - Phone:857-361-8671
Mailing Address - Fax:
Practice Address - Street 1:185 PILGRIM RD # BAKER4
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5324
Practice Address - Country:US
Practice Address - Phone:617-667-8800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program