Provider Demographics
NPI:1275500654
Name:DECAPRIO, JAMES A (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:A
Last Name:DECAPRIO
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 1:44 BINNEY ST
Mailing Address - Street 2:M457
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115
Mailing Address - Country:US
Mailing Address - Phone:617-632-3825
Mailing Address - Fax:617-632-4760
Practice Address - Street 1:44 BINNEY ST
Practice Address - Street 2:M457
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115
Practice Address - Country:US
Practice Address - Phone:617-632-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA58114207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3054829Medicaid
E30932DFOtherHPHC
53230OtherFALLON COMM HEALTH PLAN
3040020OtherUNITED HEALTH CARE
9573139OtherCIGNA
MAJ09044OtherBLUE CROSS BLUE SHIELD
058114OtherTUFTS
2062959OtherAETNA US HEALTHCARE
53230OtherFALLON COMM HEALTH PLAN
J09044Medicare ID - Type Unspecified