Provider Demographics
NPI:1730331257
Name:RADUAZZO, JOSEPH L (MD)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:L
Last Name:RADUAZZO
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1180 BEACON STREET
Mailing Address - Street 2:SUITE 8A
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446
Mailing Address - Country:US
Mailing Address - Phone:617-734-2433
Mailing Address - Fax:617-277-9821
Practice Address - Street 1:1180 BEACON STREET
Practice Address - Street 2:SUITE 8A
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446
Practice Address - Country:US
Practice Address - Phone:617-734-2433
Practice Address - Fax:617-277-9821
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-15
Last Update Date:2012-02-01
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Provider Licenses
StateLicense IDTaxonomies
MA73005207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAE02425Medicare UPIN