Healthcare Provider Details

I. General information

NPI: 1417307281
Provider Name (Legal Business Name): DEIRDRE F PUCCETTI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEIRDRE M FINNEGAN

II. Dates (important events)

Enumeration Date: 06/13/2016
Last Update Date: 12/24/2024
Certification Date: 12/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LONGWOOD AVE
BOSTON MA
02115-5724
US

IV. Provider business mailing address

300 LONGWOOD AVE
BOSTON MA
02115-5724
US

V. Phone/Fax

Practice location:
  • Phone: 617-355-6000
  • Fax:
Mailing address:
  • Phone: 617-355-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number77101
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number278936
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: