Active NPI
Carl E Dettman, M.D.
- Internal Medicine Physician
- Boston, MA
National Provider Identifier
1376593418
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 41586
- Practice address
- 150 S Huntington Ave
Boston, MA 02130-4817 - Phone
- (857) 364-4418
- Fax
- (857) 364-6546
- NPI assigned
- May 11, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 41586 | MA | Primary |
Addresses
Primary practice location
150 S Huntington Ave
Boston, MA 02130-4817
Mailing address
150 S Huntington Ave
Boston, MA 02130-4817
Phone (857) 364-4418
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)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147305600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1376593418",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "150 S HUNTINGTON AVE",
"city": "BOSTON",
"state": "MA",
"postal_code": "021304817",
"telephone_number": "857-364-4418",
"fax_number": "857-364-6546"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "150 S HUNTINGTON AVE",
"city": "BOSTON",
"state": "MA",
"postal_code": "021304817",
"telephone_number": "857-364-4418",
"fax_number": "857-364-6546"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DETTMAN",
"first_name": "CARL",
"middle_name": "E",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-11",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "MA",
"license": "41586",
"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 Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.