Basic Information
| Provider Information | |||||||||
| NPI: | 1881709111 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | D'AVILA | ||||||||
| FirstName: | ANDRELUIZ | ||||||||
| MiddleName: | BUCHELE | ||||||||
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| Credential: | MD PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 185 PILGRIM RD # BAKER4 | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 022155324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6176678800 | ||||||||
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| Practice Location | |||||||||
| Address1: | 185 PILGRIM RD # BAKER4 | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 022155324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6176678800 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2006 | ||||||||
| LastUpdateDate: | 08/28/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0001X | 283015 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology |
ID Information
| ID | Type | State | Issuer | Description | 000446300 | 05 | FL | MEDICAID |