Healthcare Provider Details

I. General information

NPI: 1336197847
Provider Name (Legal Business Name): WILLIAM JOSEPH DWYER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT ST NEONATOLOGY UNIT, FND442,MASSACHUSETTS GENERAL HOSPITAL
BOSTON MA
02114-2696
US

IV. Provider business mailing address

201 TURNPIKE ST
NORTH ANDOVER MA
01845-5005
US

V. Phone/Fax

Practice location:
  • Phone: 617-726-9040
  • Fax: 617-726-9346
Mailing address:
  • Phone: 978-697-2556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number208982
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberJ9007
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: