Healthcare Provider Details

I. General information

NPI: 1427007822
Provider Name (Legal Business Name): JOSEPH MARCEL-SAINT-LOUIS DEMERTINE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JOSEPH HEROLD MARCEL-ST-LOUIS DEMERTINE M.D.

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 02/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

581 BOYLSTON ST 800
BOSTON MA
02116-3608
US

IV. Provider business mailing address

3 ARLINGTON ST
BOSTON MA
02116-3415
US

V. Phone/Fax

Practice location:
  • Phone: 617-247-1400
  • Fax: 617-247-1411
Mailing address:
  • Phone: 617-247-1400
  • Fax: 617-247-1411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number76898
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number76898
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number76898
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number76898
License Number StateMA
# 5
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number76898
License Number StateMA
# 6
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number76898
License Number StateMA
# 7
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number233842
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: