Healthcare Provider Details

I. General information

NPI: 1962527580
Provider Name (Legal Business Name): LORA G BANKOVA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 BOYLSTON ST ALLERGY AND IMMUNOLOGY PRACTICE, SUITE 540
CHESTNUT HILL MA
02467-2477
US

IV. Provider business mailing address

1 JIMMY FUND WAY SMITH BUILDING, ROOM 638
BOSTON MA
02115-6007
US

V. Phone/Fax

Practice location:
  • Phone: 617-732-9850
  • Fax: 617-731-2748
Mailing address:
  • Phone: 617-525-1290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number253199
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: