MEDICARE: DR. JOSEPH UPTON III M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0122X	Plastic and Reconstructive Surgery Physician	41025	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	M09457	OTHER	MA	BLUE CROSS BLUE SHIELD
2	710353	OTHER	MA	TUFTS
3	B77000BI	OTHER	MA	HARVARD PILGRIM

General Provider Information

NPI Number	:	1376542191
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH UPTON III M.D.

Provider Business Mailing Address
First Line	:	PO BOX 67191
Second Line	:
City	:	CHESTNUT HILL
State	:	MA
Zip	:	02467-0002
Country	:	US
Telephone Number	:	617-739-1972
Fax Number	:	617-739-6624

Provider Business Practice Location Address
First Line	:	822 BOYLSTON ST
Second Line	:
City	:	CHESTNUT HILL
State	:	MA
Zip	:	02467-2595
Country	:	US
Telephone Number	:	617-739-1972
Fax Number	:	617-739-6624

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2005
Last Update Date	:	03/16/2019

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