MEDICARE: DR. HENRY LAWRENCE DORKIN MD

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	2080P0214X	Pediatric Pulmonology Physician	43969	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	E05370	OTHER	MA	BCBS MA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	043969	OTHER	MA	TUFTS HEALTH PLAN

General Provider Information

NPI Number	:	1427048107
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HENRY LAWRENCE DORKIN MD

Provider Business Mailing Address
First Line	:	300 LONGWOOD AVENUE
Second Line	:	HUNNEWELL 2
City	:	BOSTON
State	:	MA
Zip	:	02115
Country	:	US
Telephone Number	:	617-355-1900
Fax Number	:	617-730-0246

Provider Business Practice Location Address
First Line	:	300 LONGWOOD AVE
Second Line	:	HUNNEWELL 2
City	:	BOSTON
State	:	MA
Zip	:	02115-5724
Country	:	US
Telephone Number	:	617-355-1900
Fax Number	:	617-730-0246

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

Provider Enumeration Date	:	10/25/2005
Last Update Date	:	09/25/2008

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