Healthcare Provider Details

I. General information

NPI: 1699749002
Provider Name (Legal Business Name): DENNIS S POE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 07/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 LONGWOOD AVE FLOOR 3
BOSTON MA
02115-5711
US

IV. Provider business mailing address

300 LONGWOOD AVE LO-367
BOSTON MA
02115-5724
US

V. Phone/Fax

Practice location:
  • Phone: 617-355-6417
  • Fax:
Mailing address:
  • Phone: 617-355-6417
  • Fax: 617-730-0611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number60000
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License Number60000
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: