Healthcare Provider Details

I. General information

NPI: 1316920838
Provider Name (Legal Business Name): ADEBOYE H ADEWOYE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 06/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

732 HARRISON AVE PRESTON-3
BOSTON MA
02118-2656
US

IV. Provider business mailing address

650 ALBANY ST X-4
BOSTON MA
02118-2647
US

V. Phone/Fax

Practice location:
  • Phone: 617-638-6428
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number203479
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: