MAURICIO ALEJANDRO VILLAVICENCIO THEODULOZ (NPI# 1497153332) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1497153332 |
| Entity Type | Individual |
| Full Name | MAURICIO ALEJANDRO VILLAVICENCIO THEODULOZ |
| Credential | MD, MBA |
| Practice Address |
55 Fruit St Cox 642 Boston MA 02114-2621 |
| Mailing Address |
200 1st St Sw Rochester MN 55905-0001 |
| Practice Telephone | 6177265608 |
| Mailing Telephone | 5072842511 |
| Enumeration Date | 2014-12-09 |
| Last Update Date | 2020-10-28 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 204F00000X | Transplant Surgery | 264532 | MA | Allopathic & Osteopathic Physicians |
| Y | 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 264532 | MA | Allopathic & Osteopathic Physicians |
| Street Address |
55 FRUIT ST COX 642 |
| City | BOSTON |
| State | MA |
| Zip Code | 02114-2621 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568465888 | Michael A Nichols | Nurse Anesthetist, Certified Registered | 55 Fruit St, Boston, MA 02114-2696 | 2005-05-31 |
| 1740881374 | Katelyn Mary Bushey | Clinical Nurse Specialist | 55 Fruit St, Boston, MA 02114-2696 | 2020-11-02 |
| 1316546849 | Amy Lauren Greenblatt | Student in an Organized Health Care Education/Training Program | 55 Fruit St, Boston, MA 02114-2696 | 2020-10-26 |
| 1134728116 | Stephanie Qualls | Student in an Organized Health Care Education/Training Program | 55 Fruit St, Boston, MA 02114-2621 | 2020-10-21 |
| 1811596190 | Andrea S Hansen | Clinical Nurse Specialist | 55 Fruit St, Boston, MA 02114-2696 | 2020-10-19 |
| 1649879974 | Barbara Healy | Nurse Practitioner | 55 Fruit St, Boston, MA 02114-2696 | 2020-10-19 |
| 1770181117 | Molly Cristina Reynolds | Nurse Practitioner | 55 Fruit St, Boston, MA 02114-2621 | 2020-10-16 |
| 1245838325 | Katerina Eleni Kafkas | Nurse Practitioner | 55 Fruit St, Boston, MA 02114-2621 | 2020-10-12 |
| 1578179040 | Vivian Ellen Donahue | Registered Nurse | 55 Fruit St, Boston, MA 02114-2696 | 2020-09-21 |
| 1699380956 | Joanne Gover | Registered Nurse | 55 Fruit St, Boston, MA 02114-2621 | 2020-09-14 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588276281 | Guoliang Qiao | Student in an Organized Health Care Education/Training Program | Massachusetts General Hospital, 55 Fruit Street., Boston, MA 02114 | 2020-08-24 |
| 1881223741 | Alexander Wesley Zirulnik | Student in an Organized Health Care Education/Training Program | 55 Fruit St. Boston, Boston, MA 02114 | 2020-04-03 |
| 1376170548 | Mia Yu Bothwell | Student in an Organized Health Care Education/Training Program | Gray Bigelow 730, 55 Fruit Street, Boston, MA 02114 | 2020-03-26 |
| 1225661036 | David Dongkyung Kim | Student in an Organized Health Care Education/Training Program | 6 Whittier Place, Apartment 15b, Boston, MA 02114 | 2020-02-20 |
| 1124651658 | Madeleine Sertic | Student in an Organized Health Care Education/Training Program | Division of Abdominal Imaging, Department of Radiology, 55 Fruit Street, White 270, Boston, MA 02114 | 2020-02-12 |
| 1285274498 | Jiuk James Jung | Student in an Organized Health Care Education/Training Program | 15 Parkman Ave, Wang 4-460, Boston, MA 02114 | 2020-01-15 |
| 1831740448 | Jennifer Hughes | Physician Assistant | 55 Fruit Street, Founders 110, Boston, MA 02114 | 2019-09-25 |
| 1558827220 | Aluma Chovel Sella | Student in an Organized Health Care Education/Training Program | Massgeneral Hospital for Children Main Campus, 55 Fruit Street, Boston, MA 02114 | 2019-02-18 |
| 1083187140 | Henry Oliveras | Massage Therapist | 102 Charles Street, Boston, MA 02114 | 2019-01-10 |
| 1720550031 | Nicole M Price | Social Worker | 29 Staniford St, Boston, MA 02114 | 2018-12-27 |
| Find all providers in zip 02114 | ||||
| Taxonomy Code | 208G00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
| A thoracic surgeon provides the operative, perioperative and critical care of patients with pathologic conditions within the chest. Included is the surgical care of coronary artery disease, cancers of the lung, esophagus and chest wall, abnormalities of the trachea, abnormalities of the great vessels and heart valves, congenital anomalies, tumors of the mediastinum and diseases of the diaphragm. The management of the airway and injuries of the chest is within the scope of the specialty. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Thoracic Surgery, 2007. http://www.abts.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Thoracic Surgery. Thoracic surgeons have the knowledge, experience and technical skills to accurately diagnose, operate upon safely, and effectively manage patients with thoracic diseases of the chest. This requires substantial knowledge of cardiorespiratory physiology and oncology, as well as capability in the use of heart assist devices, management of abnormal heart rhythms and drainage of the chest cavity, respiratory support systems, endoscopy and invasive and noninvasive diagnostic techniques. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871826644 | Jennifer Lynn Wilson | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 185 Pilgrim Road, Deaconess 201, Boston, MA 02215 | 2009-09-11 |
| 1922268424 | Eric N Feins | Thoracic Surgery (Cardiothoracic Vascular Surgery) | Boston Children's Hospital -- 300 Longwood Avenue, Bader, 2nd Floor, Boston, MA 02115-5724 | 2008-06-10 |
| 1992991657 | Lana Schumacher Beal | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 55 Fruit St # 7, Boston, MA 02114-2696 | 2007-09-17 |
| 1548303936 | Robert L Thurer | Thoracic Surgery (Cardiothoracic Vascular Surgery) | Harvard Medical International, One Renaissance Pk, Ste 900, Boston, MA 02120 | 2007-02-15 |
| 1891832150 | Aditya K Kaza | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 300 Longwood Ave Bader 273, Department of Cardiac Surgery, Boston, MA 02115 | 2007-01-30 |
| 1922188580 | David A D'alessandro | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 55 Fruit Street, Cox 630, Massachusetts General Hospital, Division of Cardiac Sur, Boston, MA 02114 | 2006-10-17 |
| 1598877748 | Luis M Argote-greene | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 75 Francis St # 204, Division of Thoracic Surgery, Boston, MA 02115-6110 | 2006-08-31 |
| 1508890260 | Afshin Ehsan | Thoracic Surgery (Cardiothoracic Vascular Surgery) | Tufts New England Medical Center, 750 Washington St #266, Boston, MA 02111 | 2006-07-10 |
| 1184656605 | Sidharta P Gangadharan | Thoracic Surgery (Cardiothoracic Vascular Surgery) | Beth Israel Deaconess Med Ctr, 110 Francis St, Ste 2a, Boston, MA 02215 | 2006-07-07 |
| 1124019351 | Ciaran J Mcnamee | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 75 Francis Street, Pbb5, Room 547, Div. of Thoracic Surgery, Boston, MA 02115 | 2005-11-05 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.