Healthcare Provider Details

I. General information

NPI: 1497701866
Provider Name (Legal Business Name): ALAN STEWART PENZIAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 05/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 2ND AVE BOSTON IVF - THE WALTHAM CENTER
WALTHAM MA
02451
US

IV. Provider business mailing address

130 2ND AVE BOSTON IVF - THE WALTHAM CENTER
WALTHAM MA
02451-1100
US

V. Phone/Fax

Practice location:
  • Phone: 781-434-6500
  • Fax: 781-434-6501
Mailing address:
  • Phone: 781-434-6500
  • Fax: 781-434-6501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number272983
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number58565
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number015833
License Number StateME
# 4
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberMD11056
License Number StateRI
# 5
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number58565
License Number StateMA
# 6
Primary TaxonomyN
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number015833
License Number StateME
# 7
Primary TaxonomyN
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License NumberMD11056
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: