Healthcare Provider Details

I. General information

NPI: 1154987857
Provider Name (Legal Business Name): DAVID ADAMOWICZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2019
Last Update Date: 06/14/2024
Certification Date: 06/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 FENWOOD RD
BOSTON MA
02115-6128
US

IV. Provider business mailing address

60 FENWOOD RD
BOSTON MA
02115-6128
US

V. Phone/Fax

Practice location:
  • Phone: 619-732-6753
  • Fax:
Mailing address:
  • Phone: 619-732-6753
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number1014324
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: