Healthcare Provider Details

I. General information

NPI: 1104807551
Provider Name (Legal Business Name): RALPH BELL METSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 12/13/2019
Certification Date: 12/13/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

0 EMERSON PL STE 2D E00 2D
BOSTON MA
02114-2241
US

IV. Provider business mailing address

0 EMERSON PL STE 2D
BOSTON MA
02114-2241
US

V. Phone/Fax

Practice location:
  • Phone: 617-227-4366
  • Fax: 617-726-2894
Mailing address:
  • Phone: 617-227-4366
  • Fax: 617-726-2894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number54878
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: