Healthcare Provider Details

I. General information

NPI: 1356993539
Provider Name (Legal Business Name): CHRISTOPHER DAVID DWYER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2019
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 HUNTINGTON AVE
BOSTON MA
02115-6303
US

IV. Provider business mailing address

1626 PIERCE ST APT 309
SAN FRANCISCO CA
94115-5227
US

V. Phone/Fax

Practice location:
  • Phone: 617-525-3000
  • Fax:
Mailing address:
  • Phone: 628-666-8289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number163730
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: