Provider Demographics
NPI:1790164978
Name:SIQUEIRA, MARCELO BOGLIOLO P (MD)
Entity type:Individual
Prefix:
First Name:MARCELO
Middle Name:BOGLIOLO P
Last Name:SIQUEIRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 OBERY ST STE 100
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-2237
Mailing Address - Country:US
Mailing Address - Phone:508-210-5800
Mailing Address - Fax:508-210-5860
Practice Address - Street 1:46 OBERY ST STE 100
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-2237
Practice Address - Country:US
Practice Address - Phone:508-210-5800
Practice Address - Fax:508-210-5860
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-21
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA286040207X00000X
OH57025162207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty