IndividualActive
Mara Tietzen, MD
NPI 1831720903 · Pediatric Sports Medicine Physician · Boston, MA
Provider details
- NPI number
- 1831720903
- Entity type
- Individual
- Primary specialty
- Pediatric Sports Medicine PhysicianAllopathic & Osteopathic Physicians
- Credential
- MD
- Sex
- Female
- Sole proprietor
- Yes
- License
- 41268 (ZZ)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Allopathic & Osteopathic Physicians
Practice location
300 Longwood Ave
Boston, MA 02115-5724
Phone: (857) 218-4924
Fax: (617) 730-0683
Approximate (ZIP-level) locationGet directions
Mailing address
300 Longwood Ave
Boston, MA 02115-5724
Registry dates
- Enumerated
- 2020-01-28
- Last updated
- 2021-07-09
- Certified
- 2021-07-09
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.