Healthcare Provider Details

I. General information

NPI: 1497734768
Provider Name (Legal Business Name): LAURENCE EVANS DUCOMB MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 12/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 ROBINWOOD AVE THE ARBOUR HOSPITAL
JAMAICA PLAIN MA
02130
US

IV. Provider business mailing address

63 BRETTWOOD RD
BELMONT MA
02478-2305
US

V. Phone/Fax

Practice location:
  • Phone: 617-390-1410
  • Fax: 617-390-1595
Mailing address:
  • Phone: 617-390-1410
  • Fax: 617-390-1584

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number43588
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: