Healthcare Provider Details

I. General information

NPI: 1992134662
Provider Name (Legal Business Name): DR. MATHILDE HUPIN DEBEURME
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2013
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LONGWOOD AVE HUNNEWELL BUILDING - 221
BOSTON MA
02115-5724
US

IV. Provider business mailing address

10 JAMAICAWAY APT 5
BOSTON MA
02130-1011
US

V. Phone/Fax

Practice location:
  • Phone: 857-218-4924
  • Fax:
Mailing address:
  • Phone: 857-204-0936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License Number256138
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: