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Provider Information for 1285671875

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

MARK PUDER M.D.

Gender: MALE

Individual NPI: 1285671875

Calendar   Last Updated:  2012-12-28
  Certification Date: 

Details

Name Value
NPI 1285671875
Enumeration Date 2006-06-01
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 300 LONGWOOD AVENUE, 3RD FLOOR FEGAN BUILDING BOSTON CHILDREN'S HOSPITAL
BOSTON, MA 02115
United States

Phone: 617-355-1838 | Fax:
View Map External Link
Primary Practice Address 300 LONGWOOD AVE/FEGAN 3 CHILDREN'S HOSPITAL
BOSTON, MA 02115
United States

Phone: 617-355-3038 | Fax:
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 2086S0120X - Surgery Pediatric Surgery MA 73855