Individual
MARVIN S PACKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
291 INDEPENDENCE DR, CHESTNUT HILL, MA 02467-3628
(617) 541-6520
(617) 541-6444
Mailing address
147 MILK ST, PROVIDER ENROLLMENT - 9TH FLOOR, BOSTON, MA 02109-4806
(617) 559-8374
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
47794
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0014950
NEIGHBORHOOD HEALTH
MA
01
—
047794
TUFTS
MA
05
—
3179061
—
MA
01
—
J30278
BLUE CROSS
MA
01
—
M539
HARARD PILGRIM
MA
Enumeration date
07/07/2006
Last updated
06/27/2011
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