Healthcare Provider Details

I. General information

NPI: 1851610588
Provider Name (Legal Business Name): DAVID SPECTOR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2010
Last Update Date: 11/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 FRANCIS ST DIVISION OF SURGERY / BRIGHAM AND WOMEN'S HOSPITAL
BOSTON MA
02115-6110
US

IV. Provider business mailing address

75 FRANCIS ST DIVISION OF SURGERY / BRIGHAM AND WOMEN'S HOSPITAL
BOSTON MA
02115-6110
US

V. Phone/Fax

Practice location:
  • Phone: 617-732-5122
  • Fax:
Mailing address:
  • Phone: 617-732-5122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number243471
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: