Healthcare Provider Details

I. General information

NPI: 1568433878
Provider Name (Legal Business Name): JUSSI J. SAUKKONEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 05/18/2023
Certification Date: 05/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 VFW PKWY # GB-138
WEST ROXBURY MA
02132-4927
US

IV. Provider business mailing address

1400 VFW PKWY # GB-138
WEST ROXBURY MA
02132-4927
US

V. Phone/Fax

Practice location:
  • Phone: 857-203-6427
  • Fax: 857-203-5670
Mailing address:
  • Phone: 578-203-6427
  • Fax: 857-203-5670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number72804
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number72804
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number72804
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number72804
License Number StateMA
# 5
Primary TaxonomyN
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number72804
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: