Healthcare Provider Details

I. General information

NPI: 1316935299
Provider Name (Legal Business Name): GERALD F ABBOTT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 08/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT STREET FND 202 MGH RADIOLOGY ASSOCIATES
BOSTON MA
02114
US

IV. Provider business mailing address

PO BOX 9142 MASSACHUSETTS GENERAL PHYSICIANS ORGANIZATION INC
CHARLESTOWN MA
02114-9142
US

V. Phone/Fax

Practice location:
  • Phone: 617-724-4254
  • Fax:
Mailing address:
  • Phone: 617-724-4254
  • Fax: 617-724-0046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number39014
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: