Healthcare Provider Details

I. General information

NPI: 1679679997
Provider Name (Legal Business Name): DAVID DENOFRIO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 12/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 WASHINGTON STREET TUFTS-NEMC
BOSTON MA
02111
US

IV. Provider business mailing address

118 HUNTINGTON AVE APT 1003
BOSTON MA
02116-5770
US

V. Phone/Fax

Practice location:
  • Phone: 617-636-8068
  • Fax:
Mailing address:
  • Phone: 617-636-8068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number161339
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207RA0001X
TaxonomyAdvanced Heart Failure and Transplant Cardiology Physician
License Number161339
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: