Healthcare Provider Details

I. General information

NPI: 1053674077
Provider Name (Legal Business Name): JEREMI RICHARD MOUNTJOY M.D., FRCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2012
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT ST MASSACHUSETTS GENERAL HOSPITAL GRB 444
BOSTON MA
02114-2621
US

IV. Provider business mailing address

55 FRUIT ST MASSACHUSETTS GENERAL HOSPITAL GRB 444
BOSTON MA
02114-2621
US

V. Phone/Fax

Practice location:
  • Phone: 617-726-6705
  • Fax: 617-726-9697
Mailing address:
  • Phone: 617-726-6705
  • Fax: 617-726-9697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number250222
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: