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General NPI Number Information
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NPI Number | 1801854435
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Entity Type | Individual
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Provider Name | IVA JANDOVA M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/03/2006
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Last Update Date | 06/02/2021
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Provider Practice Location Address
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Address Line | 2100 DORCHESTER AVE STEWARD CARNEY HOSPITAL
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City | DORCHESTER
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State | MA
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Zip | 02124
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Country | US
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Telephone | 617-506-4504
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Fax |
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Provider Business Mailing Address
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Address Line | 61 LINDEN ST
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City | BROOKLINE
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State | MA
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Zip | 02445-7841
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Country | US
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Telephone | 617-710-0379
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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 | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 161099
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License Number State | MA
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