Healthcare Provider Details

I. General information

NPI: 1124002167
Provider Name (Legal Business Name): JAMES ARTHUR STREET M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2005
Last Update Date: 01/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 OLD ROAD TO 9 ACRE COR EMERSON HOSPITAL
CONCORD MA
01742-4159
US

IV. Provider business mailing address

18 WINTERBERRY WAY
BEDFORD MA
01730-1574
US

V. Phone/Fax

Practice location:
  • Phone: 978-287-3162
  • Fax: 978-287-3508
Mailing address:
  • Phone: 781-275-5997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number71834
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME 63244
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: