Healthcare Provider Details

I. General information

NPI: 1770899114
Provider Name (Legal Business Name): DROR SHALOM SHOUVAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2010
Last Update Date: 08/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LONGWOOD AVE
BOSTON MA
02115-5724
US

IV. Provider business mailing address

101 SAINT PAUL ST UNIT 2
BROOKLINE MA
02446-5103
US

V. Phone/Fax

Practice location:
  • Phone: 617-355-6058
  • Fax:
Mailing address:
  • Phone: 617-775-2621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: