Healthcare Provider Details

I. General information

NPI: 1497250260
Provider Name (Legal Business Name): JONATHAN MURRAY DURGIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2018
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 NEVINS ST SUITE 201
BRIGHTON MA
02135
US

IV. Provider business mailing address

960 MASSACHUSETTS AVE STE 2
BOSTON MA
02118-2690
US

V. Phone/Fax

Practice location:
  • Phone: 617-789-2442
  • Fax: 617-789-4207
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number285009
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: