Ethan Small Agritelley
Individual provider Active NPI Student in an Organized Health Care Education/Training Program · Boston, MA
NPI 1003754334 · NPPES record last updated Mar 25, 2026
Key facts
- NPI
- 1003754334
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Student in an Organized Health Care Education/Training Program 390200000X
- Practice address
- 55 Fruit St
Boston, MA 02114-2621 - Phone
- (617) 726-2800
- NPI assigned
- Mar 25, 2026
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | Yes |
Addresses
Primary practice location
55 Fruit St
Boston, MA 02114-2621
Mailing address
605 W Chapel Hill St Apt 562
Durham, NC 27701-2768
Phone (503) 686-5846
Other providers in Boston, MA
- Saaket Agrawal
- Shubham Agrawal
- Uday Agrawal
- Anmir Agresar-Donate
- Kimberly Hayes Agresta
- Israel David Agront
- Aurany Aguasvivas
- Chinonso Best Agubosim
- Christina Agudelo
- Julia Sroda Agudogo
All providers in Boston, MA · Student in an Organized Health Care Education/Training Program in Massachusetts
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 25, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.