Healthcare Provider Details

I. General information

NPI: 1629046776
Provider Name (Legal Business Name): LEROY MONROE PARKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 11/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 BROOKLINE AVE DANA-FARBER CANCER INSTITUTE
BOSTON MA
02215-5418
US

IV. Provider business mailing address

20 LINCOLN ROAD
WAYLAND MA
01778
US

V. Phone/Fax

Practice location:
  • Phone: 617-632-3427
  • Fax: 617-632-1930
Mailing address:
  • Phone: 508-358-2096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number37499
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: