Active NPI
Edward Douglas II
- Behavioral Neurology & Neuropsychiatry Physician
- Boston, MA
National Provider Identifier
1154984862
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavioral Neurology & Neuropsychiatry Physician
- License
- 2084B0040X
- Practice address
- 850 Harrison Ave
Boston, MA 02118-4001 - Phone
- (617) 414-4722
- Fax
- (617) 414-5520
- NPI assigned
- Apr 18, 2019
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavioral Neurology & Neuropsychiatry Physician | 2084B0040X | 2084B0040X | MA | Primary |
Addresses
Primary practice location
850 Harrison Ave
Boston, MA 02118-4001
Mailing address
850 Harrison Ave
Boston, MA 02118-4001
Phone (617) 414-4722
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2084B0040X | MA | MD | Behavioral Neurology & Neuropsychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1555545600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1555545600000",
"number": "1154984862",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "850 HARRISON AVE",
"city": "BOSTON",
"state": "MA",
"postal_code": "021184001",
"telephone_number": "617-414-4722",
"fax_number": "617-414-5520"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "850 HARRISON AVE",
"city": "BOSTON",
"state": "MA",
"postal_code": "021184001",
"telephone_number": "617-414-4722",
"fax_number": "617-414-5520"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOUGLAS",
"first_name": "EDWARD",
"name_suffix": "II",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-04-18",
"last_updated": "2019-04-18",
"status": "A"
},
"taxonomies": [
{
"code": "2084B0040X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Behavioral Neurology & Neuropsychiatry",
"state": "MA",
"license": "2084B0040X",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boston, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.