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General NPI Number Information
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NPI Number | 1487810156
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Entity Type | Individual
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Provider Name | TIMOTHY LAX MD
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Gender | Male
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Dates
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Enumeration Date | 08/01/2008
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Last Update Date | 07/07/2015
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Provider Practice Location Address
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Address Line | 1 BROOKLINE PL SUITE 623
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City | BROOKLINE
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State | MA
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Zip | 02445-7224
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Country | US
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Telephone | 617-278-8100
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Fax |
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Provider Business Mailing Address
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Address Line | 1 BROOKLINE PL SUITE 623
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City | BROOKLINE
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State | MA
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Zip | 02445-7224
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Country | US
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Telephone | 617-278-8100
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0207X
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Taxonomy Name | Pediatric Hematology & Oncology Physician
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License Number | 036120469
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number | 248449
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 207RA0201X
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Taxonomy Name | Allergy & Immunology (Internal Medicine) Physician
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License Number | 248449
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License Number State | MA
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