Provider Demographics
NPI:1003898297
Name:EBB, DAVID HENRY (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:HENRY
Last Name:EBB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-726-2737
Mailing Address - Fax:617-724-0702
Practice Address - Street 1:55 FRUIT ST, YAW 8B
Practice Address - Street 2:PEDIATRIC HEMATOLGY-ONCOLOGY
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2696
Practice Address - Country:US
Practice Address - Phone:617-726-2737
Practice Address - Fax:617-724-0702
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA77317208000000X, 2080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3111202Medicaid
MA730166OtherTUFTS HEALTH PLAN
MAJ13960OtherBCBS MA
MA730166OtherTUFTS HEALTH PLAN
MAJ13960OtherBCBS MA