Healthcare Provider Details

I. General information

NPI: 1942657556
Provider Name (Legal Business Name): DEREK SVEN STENQUIST MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2016
Last Update Date: 08/30/2022
Certification Date: 08/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MASSACHUSETTS GENERAL HOSPITAL 55 FRUIT ST.
BOSTON MA
02114
US

IV. Provider business mailing address

75 PUTNAM ST
NEEDHAM MA
02494-2223
US

V. Phone/Fax

Practice location:
  • Phone: 617-726-2942
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number267312
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME148525
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number278911
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: