Individual
PATRICK VAVKEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
300 LONGWOOD AVE, ENDERS 260, BOSTON, MA 02114
(617) 919-2105
Mailing address
4 EMERSON PLACE, APT 604, BOSTON, MA 02115
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
2
ZZ
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
1
ZZ
Other
Enumeration date
03/11/2014
Last updated
03/11/2014
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