Healthcare Provider Details

I. General information

NPI: 1477530939
Provider Name (Legal Business Name): PAUL ALFRED BOEPPLE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2005
Last Update Date: 11/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT STREET YAW 6C PEDIATRIC ENDOCRINE ASSOCIATES
BOSTON MA
02114
US

IV. Provider business mailing address

PO BOX 9142 MASS GENERAL PHYSICIAN ORGANIZATION
CHARLESTOWN MA
02129-9142
US

V. Phone/Fax

Practice location:
  • Phone: 617-726-2909
  • Fax: 617-724-0581
Mailing address:
  • Phone: 617-726-2909
  • Fax: 617-724-0581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number52300
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number52300
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: