MEDICARE: DAVID ANDREW ETTENGER IMBER

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	207LP3000X	Pediatric Anesthesiology Physician	292624	MA

General Provider Information

NPI Number	:	1598224305
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID ANDREW ETTENGER IMBER

Provider Business Mailing Address
First Line	:	300 LONGWOOD AVE
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02115-5724
Country	:	US
Telephone Number	:	617-355-6000
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 LONGWOOD AVE
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02115-5724
Country	:	US
Telephone Number	:	617-355-6000
Fax Number	:

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

Provider Enumeration Date	:	03/19/2019
Last Update Date	:	05/27/2026

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