Individual
DR. JASON ANDREW FAWLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
15 PARKMAN STREET, CHURCHILL SURGICAL CLINIC, BOST, MA 02114-3117
(617) 643-7557
Mailing address
165 CAMBRIDGE ST STE 810, BOSTON, MA 02114-2747
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
280467
MA
2086S0102X
Surgical Critical Care Physician
280467
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1114218146
—
WI
Enumeration date
04/25/2011
Last updated
10/04/2019
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