Provider Demographics
NPI:1831152024
Name:BEVIVINO, RALPH EDWARD (MD)
Entity type:Individual
Prefix:DR
First Name:RALPH
Middle Name:EDWARD
Last Name:BEVIVINO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:720 HARRISON AVE
Mailing Address - Street 2:DOB 503
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:900 WASHINGTON ST
Practice Address - Street 2:SUITE C
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-3498
Practice Address - Country:US
Practice Address - Phone:617-414-9400
Practice Address - Fax:781-762-2677
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-09
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA44699207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease