Healthcare Provider Details

I. General information

NPI: 1043234099
Provider Name (Legal Business Name): JONATHAN M PINCUS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 01/04/2024
Certification Date: 01/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 ALBANY ST SHAPIRO 9, SUITE B
BOSTON MA
02118-2526
US

IV. Provider business mailing address

637 WASHINGTON ST
DORCHESTER MA
02124-3510
US

V. Phone/Fax

Practice location:
  • Phone: 617-414-4290
  • Fax: 617-414-4285
Mailing address:
  • Phone: 617-825-9660
  • Fax: 617-288-7898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number79005
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: