=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316935299
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GERALD F ABBOTT MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/13/2005
-----------------------------------------------------
Last Update Date | 08/21/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 55 FRUIT STREET FND 202 MGH RADIOLOGY ASSOCIATES
-----------------------------------------------------
City | BOSTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02114
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-724-4254
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 9142 MASSACHUSETTS GENERAL PHYSICIANS ORGANIZATION INC
-----------------------------------------------------
City | CHARLESTOWN
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02114-9142
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-724-4254
-----------------------------------------------------
Fax | 617-724-0046
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number | 39014
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------