Provider Demographics
NPI:1750873816
Name:RIVERA, ISMAEL FELIPE (MD)
Entity type:Individual
Prefix:
First Name:ISMAEL
Middle Name:FELIPE
Last Name:RIVERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:133 OLD ROAD TO NAC COR
Mailing Address - Street 2:DEPT. OF HOSPITAL MEDICINE
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-4159
Mailing Address - Country:US
Mailing Address - Phone:978-287-3167
Mailing Address - Fax:
Practice Address - Street 1:133 OLD ROAD TO 9 ACRE COR
Practice Address - Street 2:DEPT OF HOSPITAL MEDICINE
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-4169
Practice Address - Country:US
Practice Address - Phone:978-287-8311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-05
Last Update Date:2023-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMT215340207Q00000X
PAMD475400207Q00000X
MA290810207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine