Healthcare Provider Details

I. General information

NPI: 1518195585
Provider Name (Legal Business Name): ALFRED LIONEL HURST M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2009
Last Update Date: 06/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 SEQUATTON LN
HARWICH PORT MA
02646-2256
US

IV. Provider business mailing address

PO BOX 215
HARWICH PORT MA
02646-0215
US

V. Phone/Fax

Practice location:
  • Phone: 508-432-3463
  • Fax:
Mailing address:
  • Phone: 508-432-3463
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number23869
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: