Healthcare Provider Details

I. General information

NPI: 1588366389
Provider Name (Legal Business Name): LAWSON BRADLEY TRAYLOR JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2023
Last Update Date: 05/30/2026
Certification Date: 05/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 E CONCORD ST STE 3000
BOSTON MA
02118-2335
US

IV. Provider business mailing address

85 E CONCORD ST STE 3000
BOSTON MA
02118-2335
US

V. Phone/Fax

Practice location:
  • Phone: 617-638-8442
  • Fax:
Mailing address:
  • Phone: 617-638-8442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number1028192
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: