Healthcare Provider Details

I. General information

NPI: 1548857055
Provider Name (Legal Business Name): LEAH BELLE KOSYAKOVSKY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2020
Last Update Date: 02/14/2021
Certification Date: 02/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 PILGRIM RD # BAKER4
BOSTON MA
02215-5324
US

IV. Provider business mailing address

185 PILGRIM RD # BAKER4
BOSTON MA
02215-5324
US

V. Phone/Fax

Practice location:
  • Phone: 617-667-8800
  • Fax:
Mailing address:
  • Phone: 617-632-7828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberPENDING
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: