Provider Demographics
NPI:1083192413
Name:BLOCH MURADAS, ANA RUTE (MD)
Entity type:Individual
Prefix:
First Name:ANA RUTE
Middle Name:
Last Name:BLOCH MURADAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANA RUTE
Other - Middle Name:
Other - Last Name:CARRERO BLOCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1901 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-7491
Mailing Address - Country:US
Mailing Address - Phone:212-423-6271
Mailing Address - Fax:
Practice Address - Street 1:45 DIMOCK ST
Practice Address - Street 2:
Practice Address - City:ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02119-1208
Practice Address - Country:US
Practice Address - Phone:617-442-8800
Practice Address - Fax:617-442-4088
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-28
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MA290921208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program