Provider Demographics
NPI:1881335925
Name:MACHADO RIVAS, FEDEL ANDRES (MD)
Entity type:Individual
Prefix:
First Name:FEDEL ANDRES
Middle Name:
Last Name:MACHADO RIVAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:FEDEL
Other - Middle Name:
Other - Last Name:MACHADO-RIVAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:55 FRUIT STREET
Mailing Address - Street 2:AUSTEN 210
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2621
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:55 FRUIT STREET
Practice Address - Street 2:AUSTEN 210
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:617-726-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-05
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA30135792085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology