Healthcare Provider Details

I. General information

NPI: 1699742247
Provider Name (Legal Business Name): HARLAND STEVEN WINTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2006
Last Update Date: 09/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 CAMBRIDGE ST CPZS 5-560
BOSTON MA
02114-2743
US

IV. Provider business mailing address

PO BOX 9142
CHARLESTOWN MA
02129-9142
US

V. Phone/Fax

Practice location:
  • Phone: 617-726-8705
  • Fax: 617-724-2710
Mailing address:
  • Phone: 617-726-1450
  • Fax: 617-724-2710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number41227
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number41227
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: