Healthcare Provider Details

I. General information

NPI: 1710954391
Provider Name (Legal Business Name): PETER C ENZINGER DR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 BINNEY ST DANA-FARBER CANCER INST
BOSTON MA
02115-6013
US

IV. Provider business mailing address

11 DANE ST
JAMAICA PLAIN MA
02130
US

V. Phone/Fax

Practice location:
  • Phone: 617-632-6855
  • Fax: 617-632-5370
Mailing address:
  • Phone: 617-632-6855
  • Fax: 617-632-5370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number160952
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: