Healthcare Provider Details

I. General information

NPI: 1053057851
Provider Name (Legal Business Name): EKIN SIMWATACHELA MBCHB
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2022
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 HARRISON AVE BLDG 4TH
BOSTON MA
02118-2905
US

IV. Provider business mailing address

820 HARRISON AVE BLDG 4TH
BOSTON MA
02118-2905
US

V. Phone/Fax

Practice location:
  • Phone: 617-414-4978
  • Fax:
Mailing address:
  • Phone: 617-414-4978
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME178761
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number1025758
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: