Healthcare Provider Details

I. General information

NPI: 1356306336
Provider Name (Legal Business Name): FRANK B POMPOSELLI JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 08/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 WARREN ST THIRD FLOOR
BOSTON MA
02135-3601
US

IV. Provider business mailing address

77 WARREN ST THIRD FLOOR
BOSTON MA
02135-3601
US

V. Phone/Fax

Practice location:
  • Phone: 617-789-3000
  • Fax:
Mailing address:
  • Phone: 617-789-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number47409
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: