Healthcare Provider Details

I. General information

NPI: 1407306731
Provider Name (Legal Business Name): COLIN FLYNN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2016
Last Update Date: 11/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

732 HARRISON AVE PRESTON, 3RD FLOOR
BOSTON MA
02118-2309
US

IV. Provider business mailing address

720 HARRISON AVE DOB 503
BOSTON MA
02118-2371
US

V. Phone/Fax

Practice location:
  • Phone: 617-638-8488
  • Fax: 617-638-8469
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA5921
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: