Healthcare Provider Details

I. General information

NPI: 1518383587
Provider Name (Legal Business Name): JAAKKO LAPPALAINEN MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2014
Last Update Date: 03/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 WOODLAND AVE VA/MIRECC
PHILADELPHIA PA
19104-4551
US

IV. Provider business mailing address

802 BLACKSHIRE RD
WILMINGTON DE
19805-2807
US

V. Phone/Fax

Practice location:
  • Phone: 203-676-1599
  • Fax:
Mailing address:
  • Phone: 203-676-1599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number038241
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License NumberMD449638
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: