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Provider Information for 1285653766

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know


Gender: MALE

Individual NPI: 1285653766

Calendar   Last Updated:  2007-07-08
  Certification Date: 


Name Value
NPI 1285653766
Enumeration Date 2006-07-18
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 16 CRAFTSLAND RD
CHESTNUT HILL, MA 02467-2632
United States

Phone: 617-277-0753 | Fax:
View Map External Link
Primary Practice Address 300 LONGWOOD AVE FEGAN 3
BOSTON, MA 02115-5724
United States

Phone: 617-355-3039 | Fax: 617-730-0298
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Primary Taxonomy Selected Taxonomy State License Number
No 204F00000X - Transplant Surgery MA 46255
No 208600000X - Surgery MA 46255
No 2086S0102X - Surgery Surgical Critical Care MA 46255
No 208G00000X - Thoracic Surgery (Cardiothoracic Vascular Surgery) MA 46255