Healthcare Provider Details

I. General information

NPI: 1538249263
Provider Name (Legal Business Name): LEONARD I FIRER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 11/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 BEACH ST
REVERE MA
02151-3143
US

IV. Provider business mailing address

17 GILBERT ST
WALTHAM MA
02453-6807
US

V. Phone/Fax

Practice location:
  • Phone: 781-289-5057
  • Fax:
Mailing address:
  • Phone: 781-209-0164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number226608
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: