Healthcare Provider Details

I. General information

NPI: 1245432434
Provider Name (Legal Business Name): JOANNA LYNN D'AFFLITTI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 02/02/2022
Certification Date: 02/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

780 ALBANY ST
BOSTON MA
02118-2755
US

IV. Provider business mailing address

801 ALBANY STREET FL GROUND
BOSTON MA
02119
US

V. Phone/Fax

Practice location:
  • Phone: 857-654-1000
  • Fax: 857-654-1100
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberLP01095
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number245364
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number245364
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: