Individual
CHRISTOPHER L DEFAZIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
585 LEBANON ST, MELROSE, MA 02176
(781) 979-3635
(781) 979-3018
Mailing address
114 HARRIS AVE, NEEDHAM, MA 02492
(781) 444-1536
(781) 979-3018
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
58772
MA
207R00000X
Internal Medicine Physician
58772
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
058772
TUFTS
—
05
—
3042596
—
MA
01
—
665716
HARVARD PILGRIM
—
01
—
J07968
BCBS
—
Enumeration date
02/27/2006
Last updated
05/07/2008
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