Individual
WALLACE BOURGEOIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
450 BROOKLINE AVE, BOSTON, MA 02215-5418
(617) 632-2423
Mailing address
44 BINNEY ST # D-3119, BOSTON, MA 02115-6013
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
274015
MA
2080P0207X
Pediatric Hematology & Oncology Physician
Primary
274015
MA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/24/2014
Last updated
02/22/2021
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