Healthcare Provider Details

I. General information

NPI: 1851709273
Provider Name (Legal Business Name): AMERICAN WELL PHYSICIANS FLORIDA, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2014
Last Update Date: 01/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 STATE ST FL 26
BOSTON MA
02109-1827
US

IV. Provider business mailing address

75 STATE ST FL 26
BOSTON MA
02109-1827
US

V. Phone/Fax

Practice location:
  • Phone: 617-204-3500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. PETER ANTALL
Title or Position: PRESIDENT
Credential:
Phone: 617-204-3500