Provider Demographics
NPI:1770681017
Name:FAXON, DAVID PARKER (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:PARKER
Last Name:FAXON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 TREMONT ST
Mailing Address - Street 2:OBC-3-12J
Mailing Address - City:ROXBURY CROSSING
Mailing Address - State:MA
Mailing Address - Zip Code:02120-1613
Mailing Address - Country:US
Mailing Address - Phone:617-525-8358
Mailing Address - Fax:
Practice Address - Street 1:1620 TREMONT ST
Practice Address - Street 2:OBC-3-12P
Practice Address - City:ROXBURY CROSSING
Practice Address - State:MA
Practice Address - Zip Code:02120-1613
Practice Address - Country:US
Practice Address - Phone:617-525-8358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA37416207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology