Provider Demographics
NPI:1952389892
Name:NARDONE, OTTAVIO (MD)
Entity Type:Individual
Prefix:DR
First Name:OTTAVIO
Middle Name:
Last Name:NARDONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:358 HANOVER ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02113-1302
Mailing Address - Country:US
Mailing Address - Phone:617-227-5201
Mailing Address - Fax:617-314-7959
Practice Address - Street 1:358 HANOVER ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02113-1302
Practice Address - Country:US
Practice Address - Phone:617-227-5201
Practice Address - Fax:617-314-7959
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-01
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA151255207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3159639Medicaid
MAG35057Medicare UPIN
MAA21742Medicare ID - Type Unspecified