Healthcare Provider Details

I. General information

NPI: 1720517303
Provider Name (Legal Business Name): IAN HOPEWOOD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2017
Last Update Date: 07/27/2020
Certification Date: 07/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 CITY HALL MALL
MEDFORD MA
02155-4754
US

IV. Provider business mailing address

26 CITY HALL MALL
MEDFORD MA
02155-4754
US

V. Phone/Fax

Practice location:
  • Phone: 781-306-5100
  • Fax:
Mailing address:
  • Phone: 781-306-5100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number282229
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: