Healthcare Provider Details

I. General information

NPI: 1467208595
Provider Name (Legal Business Name): NICOLE HWANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2024
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BOSTON MEDICAL CTR PL STE 1
BOSTON MA
02118-2999
US

IV. Provider business mailing address

1 BOSTON MEDICAL CTR PL STE 1
BOSTON MA
02118-2999
US

V. Phone/Fax

Practice location:
  • Phone: 267-373-7100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number1467208595
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: