Healthcare Provider Details

I. General information

NPI: 1467688960
Provider Name (Legal Business Name): JEREMY RYAN A PENA MD, PHD, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2009
Last Update Date: 11/01/2025
Certification Date: 11/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT ST MGH
BOSTON MA
02114-2696
US

IV. Provider business mailing address

55 FRUIT STREET MASSACHUSETTS GENERAL HOSPITAL
BOSTON MA
02114
US

V. Phone/Fax

Practice location:
  • Phone: 617-726-0967
  • Fax:
Mailing address:
  • Phone: 617-726-0967
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZB0001X
TaxonomyBlood Banking & Transfusion Medicine Physician
License Number250350
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207ZC0006X
TaxonomyClinical Pathology Physician
License Number250350
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: