Healthcare Provider Details

I. General information

NPI: 1568411320
Provider Name (Legal Business Name): YAMIN DOU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 03/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 MALL RD LAHEY CLINIC
BURLINGTON MA
01805-0001
US

IV. Provider business mailing address

41 MALL RD LAHEY CLINIC
BURLINGTON MA
01805-0001
US

V. Phone/Fax

Practice location:
  • Phone: 781-744-8170
  • Fax: 781-744-5232
Mailing address:
  • Phone: 781-744-8170
  • Fax: 781-744-5232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207UN0902X
TaxonomyNuclear Imaging & Therapy Physician
License Number215440
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: