Provider Demographics
NPI:1457402323
Name:KWON, DOUGLAS (MD, PHD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:
Last Name:KWON
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 FRANCIS ST PBB A4
Mailing Address - Street 2:BRIGHAM & WOMEN'S HOSPITAL- INFECTIOUS DISEASE DIVISION
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15 FRANCIS ST PBB A4
Practice Address - Street 2:BRIGHAM & WOMEN'S HOSPITAL- INFECTIOUS DISEASE DIVISION
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115
Practice Address - Country:US
Practice Address - Phone:617-732-8881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MABB5204071207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease