Provider Demographics
NPI:1437266491
Name:TORRES-LEON, MARIO EDUARDO (MD)
Entity type:Individual
Prefix:
First Name:MARIO
Middle Name:EDUARDO
Last Name:TORRES-LEON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 615
Mailing Address - Street 2:
Mailing Address - City:WEST ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720
Mailing Address - Country:US
Mailing Address - Phone:978-266-2676
Mailing Address - Fax:978-266-2680
Practice Address - Street 1:1 GENERAL ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01841-2961
Practice Address - Country:US
Practice Address - Phone:978-946-8103
Practice Address - Fax:978-946-8067
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA2209042085R0202X, 2085R0204X
PR153632085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA73658OtherHEALTHY START
MAAA80872OtherHPHC
NH30206517OtherNH MEDICAID
MA2060281Medicaid
MA469118OtherTUFTS HEALTH PLAN
MA11438706OtherCAQH
MA2632995OtherCIGNA
MAP0038679OtherRR MEDICARE
NH01Y011490MA01OtherNH BLUE SHIELD ANTHEM
MA7321567OtherAETNA/USHC
MA91957OtherFALLON
MAJ27466OtherBLUE CROSS-BLUE SHIELD
NH30206517OtherNH MEDICAID
MAP0038679OtherRR MEDICARE