Fawley, Jason Andrew

Fawley, Jason Andrew is an individual health care provider with primary practice located at 15 Parkman Street Churchill Surgical Clinic, Bost MA 02114-3117. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Surgical Critical Care, Allopathic & Osteopathic Physicians / Surgery. Allopathic & Osteopathic Physicians / Surgery is his primary health care specialty. Fawley, Jason Andrew can be contacted via phone (617) 643-7557.

Contact Information

Primary practice address
15 Parkman Street Churchill Surgical Clinic Bost MA 02114-3117
Phone: (617) 643-7557
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Surgical Critical Care 2086S0102X 280467 Massachusetts
Allopathic & Osteopathic Physicians / Surgery 208600000X 280467 Massachusetts

Profile Details

NPI number 1114218146
LBN Legal business name Fawley, Jason Andrew
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 25th, 2011
Last updated Oct 4th, 2019 - about 7 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1114218146 NPPES
Wisconsin MEDICAID 1114218146

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