Healthcare Provider Details

I. General information

NPI: 1497745517
Provider Name (Legal Business Name): CARLOS I DURAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2005
Last Update Date: 04/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 WASHINGTON ST TUFTS MEDICAL CENTER
BOSTON MA
02111-1552
US

IV. Provider business mailing address

800 WASHINGTON ST TUFTS MEDICAL CENTER
BOSTON MA
02111-1552
US

V. Phone/Fax

Practice location:
  • Phone: 617-636-5000
  • Fax: 617-636-5000
Mailing address:
  • Phone: 617-636-5000
  • Fax: 617-636-5000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number210408
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number210408
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number210408
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: