Healthcare Provider Details

I. General information

NPI: 1649269531
Provider Name (Legal Business Name): WILLIAM GERALD AUSTEN JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2005
Last Update Date: 04/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 PARKMAN STREET WACC 435
BOSTON MA
02114-3117
US

IV. Provider business mailing address

15 PARKMAN STREET WACC 435
BOSTON MA
02114-3117
US

V. Phone/Fax

Practice location:
  • Phone: 617-724-9922
  • Fax: 617-726-8089
Mailing address:
  • Phone: 617-724-9922
  • Fax: 617-726-8089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number153973
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: