Healthcare Provider Details

I. General information

NPI: 1770162042
Provider Name (Legal Business Name): GEOFFREY JOSEPH SEDOR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2021
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 HARRISON AVE, LL100 MOAKLEY BLDG
BOSTON MA
02118-2905
US

IV. Provider business mailing address

960 MASSACHUSETTS AVE FL 2
BOSTON MA
02118-2690
US

V. Phone/Fax

Practice location:
  • Phone: 617-638-7070
  • Fax: 617-638-7037
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number1028073
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: