Provider Demographics
NPI:1629046776
Name:PARKER, LEROY MONROE (MD)
Entity Type:Individual
Prefix:
First Name:LEROY
Middle Name:MONROE
Last Name:PARKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 LINCOLN ROAD
Mailing Address - Street 2:
Mailing Address - City:WAYLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01778
Mailing Address - Country:US
Mailing Address - Phone:508-358-2096
Mailing Address - Fax:
Practice Address - Street 1:450 BROOKLINE AVE
Practice Address - Street 2:DANA-FARBER CANCER INSTITUTE
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5418
Practice Address - Country:US
Practice Address - Phone:617-632-3427
Practice Address - Fax:617-632-1930
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA37499207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
3004556OtherUNITED HEALTH CARE
037499OtherTUFTS
110128571OtherRR MEDICARE DFCI
38108OtherFALLON COMMUNITY HEALTH
MA2040808Medicaid
8350324OtherCIGNA
B75955DFOtherHPHC DFCI ONLY
MAM09083OtherBCBS INDEMNITY ELECT HMO
2066693OtherAETNA US HEALTHCARE
3004556OtherUNITED HEALTH CARE
MA2040808Medicaid