Individual
GREGORY P DECONCILIIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
P.A.-C
Contact information
Practice address
840 WINTER ST., BOSTON OUT-PATIENT SURGICAL SUITES, LLC, WALTHAM, MA 02451
(781) 895-4908
(781) 895-4902
Mailing address
22 CHARLEMONT ST, NEWTON, MA 02461-1908
(617) 233-6804
(781) 207-0204
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
1250
MA
Other
Enumeration date
05/15/2007
Last updated
07/08/2007
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