Healthcare Provider Details

I. General information

NPI: 1801820659
Provider Name (Legal Business Name): DEREK A BARCLAY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BRIGHAM AND WOMEN'S HOSPITAL 75 FRANCIS STREET, NEVILLE HOUSE
BOSTON MA
02115
US

IV. Provider business mailing address

20 NORRIS ST APARTMENT #2
CAMBRIDGE MA
02140-1815
US

V. Phone/Fax

Practice location:
  • Phone: 617-732-5656
  • Fax:
Mailing address:
  • Phone: 617-732-5656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PT0002X
TaxonomyMedical Toxicology (Emergency Medicine) Physician
License Number226628
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: