Healthcare Provider Details

I. General information

NPI: 1295773588
Provider Name (Legal Business Name): GREGORY S SAWICKI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LONGWOOD AVENUE CHILDRENS HOSPITAL
BOSTON MA
02115
US

IV. Provider business mailing address

3 MULLINS CT
CAMBRIDGE MA
02141-1221
US

V. Phone/Fax

Practice location:
  • Phone: 617-355-6105
  • Fax:
Mailing address:
  • Phone: 617-355-6105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number226814
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: