Healthcare Provider Details

I. General information

NPI: 1285695387
Provider Name (Legal Business Name): GREGORY P PRIEBE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 08/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LONGWOOD AVE DIV. CRITICAL CARE MED. CHILDREN'S HOSP. BOSTON BADER 6
BOSTON MA
02115-5724
US

IV. Provider business mailing address

300 LONGWOOD AVE DIV. CRITICAL CARE MED. CHILDREN'S HOSP. BOSTON BADER 6
BOSTON MA
02115-5724
US

V. Phone/Fax

Practice location:
  • Phone: 617-355-7327
  • Fax:
Mailing address:
  • Phone: 617-355-7327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number151573
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License Number151573
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: