Healthcare Provider Details

I. General information

NPI: 1851463202
Provider Name (Legal Business Name): JEREMY STUART DUFFIELD M.D. PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 FRANCIS ST BRIGHAM MEDICAL SPECIALTIES
BOSTON MA
02115-6110
US

IV. Provider business mailing address

4 BLACKFAN CIR HARVARD INSTITUTES OF MEDICINE ROOM 574
BOSTON MA
02115-5713
US

V. Phone/Fax

Practice location:
  • Phone: 617-732-6383
  • Fax: 617-525-5830
Mailing address:
  • Phone: 617-525-5914
  • Fax: 617-525-5830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number230001
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: