Healthcare Provider Details

I. General information

NPI: 1114161783
Provider Name (Legal Business Name): LAUREN ULLMAN MADOFF M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LAUREN MARIE ULLMAN M.D.

II. Dates (important events)

Enumeration Date: 04/28/2009
Last Update Date: 06/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 BROOKLINE AVE DEPARTMENT OF ANESTHESIA
BOSTON MA
02215-5400
US

IV. Provider business mailing address

300 LONGWOOD AVE DEPARTMENT OF ANESTHESIA
BOSTON MA
02115
US

V. Phone/Fax

Practice location:
  • Phone: 617-754-2713
  • Fax:
Mailing address:
  • Phone: 617-355-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number252876
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number252876
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: