Mizner, Richard Eric

Mizner, Richard Eric is an individual health care provider with primary practice located at 55 Fruit St Pediatric Group Practice Yaw 6, Boston MA 02114-2621. He recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as his primary health care specialty. Mizner, Richard Eric can be contacted via phone (617) 726-2728.

Contact Information

Primary practice address
55 Fruit St Pediatric Group Practice Yaw 6 Boston MA 02114-2621
Phone: (617) 726-2728
Fax: (617) 724-3948
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 81000 Massachusetts

Profile Details

NPI number 1417947292
LBN Legal business name Mizner, Richard Eric
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 24th, 2005
Last updated Jul 31st, 2012 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1417947292 NPPES
Massachusetts Other 087000 TUFTS HEALTH PLAN
Massachusetts Other J31195 TUFTS HEALTH PLAN
Massachusetts MEDICAID 3138046 TUFTS HEALTH PLAN

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