Basic Information
| Provider Information | |||||||||
| NPI: | 1447240999 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PENSON | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | T | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 9142 | ||||||||
| Address2: | MASS. GENERAL PHYSICIAN ORGANIZATION | ||||||||
| City: | CHARLESTOWN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021299142 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6177244800 | ||||||||
| FaxNumber: | 6177265867 | ||||||||
| Practice Location | |||||||||
| Address1: | 55 FRUIT ST YAW 9 | ||||||||
| Address2: | HEMATOLOGY/ONCOLOGY | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021142621 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6177245951 | ||||||||
| FaxNumber: | 6177246898 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2005 | ||||||||
| LastUpdateDate: | 01/11/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RX0202X | 209994 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology | 207R00000X | 209994 | MA | N | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | J23774 | 01 | MA | BCBS OF MA | OTHER | 2065771 | 05 | MA | MEDICAID | 209279 | 01 | MA | TUFTS HEALTH PLAN | OTHER |