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NPI Code Detail

MEDICARE: DR. JONATHAN OREN LIPTON M.D., PH.D.

MEDICARE: DR. JONATHAN OREN LIPTON M.D., PH.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084N0400XNeurology Physician224330MA
22084N0402XNeurology with Special Qualifications in Child Neurology Physician224330MA
32080S0012XPediatric Sleep Medicine Physician235269MA

General Provider Information

NPI Number : 1134305071
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JONATHAN OREN LIPTON M.D., PH.D.
Provider Business Mailing Address
First Line : 300 LONGWOOD AVENUE, DEPARTMENT OF NEUROLOGY
Second Line : FEGAN 11
City : BOSTON
State : MA
Zip : 02115
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 300 LONGWOOD AVE DEPT OF
Second Line : FEGAN 11
City : BOSTON
State : MA
Zip : 02115-5724
Country : US
Telephone Number : 617-355-2067
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/10/2008
Last Update Date : 01/22/2015

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