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NPI Code Detail

MEDICARE: JOHN FIADJOE M.D.

MEDICARE:   JOHN  FIADJOE  M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207L00000XAnesthesiology PhysicianMD423799PA
2207LP3000XPediatric Anesthesiology PhysicianMD423799PA
3207LP3000XPediatric Anesthesiology Physician286278MA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1183049EJLOTHERPAMEDICARE PTAN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1881701464
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN FIADJOE M.D.
Provider Business Mailing Address
First Line : 300 LONGWOOD AVE
Second Line :
City : BOSTON
State : MA
Zip : 02115-5724
Country : US
Telephone Number : 617-355-6000
Fax Number : 267-425-9331
Provider Business Practice Location Address
First Line : 300 LONGWOOD AVE
Second Line :
City : BOSTON
State : MA
Zip : 02115-5724
Country : US
Telephone Number : 617-355-6000
Fax Number : 267-425-9331
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/23/2006
Last Update Date : 04/09/2021

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