Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Wallace Bourgeois, MD

Individual provider Pediatrics Physician · NPI 1811317209

Wallace Bourgeois, MD is a Pediatrics Physician in Boston, Massachusetts. Works from 2 locations. Licensed in Massachusetts.

Licensed in
MA
In the registry since
2014
Specialties on file
3
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

450 Brookline Ave
Boston, MA 02215-5418
Phone: (617) 632-2423
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 300 Longwood Ave, Boston, MA 02115-5724 — (617) 355-6000

Specialties & licences

Pediatric Hematology & Oncology Physician (primary) Taxonomy 2080P0207X · Licence 274015 (MA)
Pediatrics Physician Taxonomy 208000000X · Licence 274015 (MA)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X

Record details

NPI number1811317209
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedApril 24, 2014
Last updated in NPPESFebruary 22, 2021
Certification dateFebruary 22, 2021
Mailing address44 Binney St # D-3119, Boston, MA 02115-6013

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