Basic Information
Provider Information
NPI: 1033558093
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FLAVIN
FirstName: MARISA
MiddleName:  
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Credential: M.D.
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Mailing Information
Address1: 13001 E 17TH PL
Address2:  
City: AURORA
State: CO
PostalCode: 800452570
CountryCode: US
TelephoneNumber: 7034034422
FaxNumber:  
Practice Location
Address1: 300 1ST AVE
Address2:  
City: BOSTON
State: MA
PostalCode: 021293109
CountryCode: US
TelephoneNumber: 7034034422
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/22/2013
LastUpdateDate: 04/07/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
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IsSoleProprietor: N
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AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X256291MAN Allopathic & Osteopathic PhysiciansInternal Medicine 
208100000X256291MAY Allopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation 

No ID Information.


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