Healthcare Provider Details

I. General information

NPI: 1760623300
Provider Name (Legal Business Name): OLAV ISTRE M.D., PH.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2009
Last Update Date: 05/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 FRANCIS ST BRIGHAM & WOMEN'S HOSPITAL OBGYN
BOSTON MA
02115-6110
US

IV. Provider business mailing address

75 FRANCIS ST BRIGHAM & WOMEN'S HOSPITAL OBGYN
BOSTON MA
02115-6110
US

V. Phone/Fax

Practice location:
  • Phone: 617-525-8599
  • Fax: 617-975-0900
Mailing address:
  • Phone: 617-525-8599
  • Fax: 617-975-0900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number233951
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: