Healthcare Provider Details

I. General information

NPI: 1033136833
Provider Name (Legal Business Name): DEREK JOSEPH TRAPASSO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 05/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

332 HANOVER ST NORTH END COMMUNITY HEALTH CENTER
BOSTON MA
02113-1901
US

IV. Provider business mailing address

332 HANOVER ST NORTH END COMMUNITY HEALTH CENTER
BOSTON MA
02113-1901
US

V. Phone/Fax

Practice location:
  • Phone: 617-643-8000
  • Fax: 617-643-8120
Mailing address:
  • Phone: 617-643-8000
  • Fax: 617-643-8120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number226326
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: