Healthcare Provider Details

I. General information

NPI: 1487844403
Provider Name (Legal Business Name): JONATHAN M GAFFIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2007
Last Update Date: 09/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LONGWOOD AVE # 208
BOSTON MA
02115-5724
US

IV. Provider business mailing address

300 LONGWOOD AVE # 208
BOSTON MA
02115-5724
US

V. Phone/Fax

Practice location:
  • Phone: 617-355-6953
  • Fax:
Mailing address:
  • Phone: 617-355-6953
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number240274
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number240274
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: