Provider Demographics
NPI:1508896853
Name:WALENSKY, LOREN DAVID (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:LOREN
Middle Name:DAVID
Last Name:WALENSKY
Suffix:
Gender:M
Credentials:MD PHD
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Mailing Address - Street 1:44 BINNEY STREET
Mailing Address - Street 2:D322A DANA FARBER CANCER INSTITUTE
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115
Mailing Address - Country:US
Mailing Address - Phone:617-632-6307
Mailing Address - Fax:617-632-6401
Practice Address - Street 1:44 BINNEY STREET
Practice Address - Street 2:DANA FARBER CANCER INSTITUTE DANA 3 JIMMY FUND CLINIC
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115
Practice Address - Country:US
Practice Address - Phone:617-632-6794
Practice Address - Fax:617-632-3310
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-09
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Provider Licenses
StateLicense IDTaxonomies
MA2048392080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
7493680OtherCIGNA
1160345OtherFALLON COMMUNITY HEALTH
MA2000971Medicaid
204839OtherTUFTS
000000029367OtherBMC HEALTHNET
MAJ25849OtherBLUE CROSS BLUE SHIELD OF
206434OtherHPHC
MAJ25849OtherBLUE CROSS BLUE SHIELD OF
7493680OtherCIGNA