Healthcare Provider Details

I. General information

NPI: 1982865705
Provider Name (Legal Business Name): DUNCAN M HENRY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2008
Last Update Date: 02/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 HARRISON AVE MENINO 4
BOSTON MA
02118-2905
US

IV. Provider business mailing address

1 BOSTON MEDICAL CTR PL DEPARTMENT OF PEDIATRICS, DOWLING 3 SOUTH
BOSTON MA
02118-2908
US

V. Phone/Fax

Practice location:
  • Phone: 617-414-4511
  • Fax: 617-414-3171
Mailing address:
  • Phone: 617-414-5170
  • Fax: 617-414-3803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number247020
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: