Healthcare Provider Details

I. General information

NPI: 1457390601
Provider Name (Legal Business Name): YELENA KAMENKER-ORLOV M.D., PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: YELENA KAMENKER M.D.,PH.D.

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 02/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WEST ROXBURY VA MEDICAL CENTER, AMBULATORY CARE 1400 VFW PARKWAY
WEST ROXBURY MA
02132
US

IV. Provider business mailing address

542 LOWELL AVE
NEWTON MA
02460-2353
US

V. Phone/Fax

Practice location:
  • Phone: 857-203-3000
  • Fax:
Mailing address:
  • Phone: 617-916-9626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number157520
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number157520
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: