MEDICARE: DR. JOHN JAMOULIS JAMESON MD

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
1	207Y00000X	Otolaryngology Physician	72421	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770578528
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN JAMOULIS JAMESON MD

Provider Business Mailing Address
First Line	:	960 MASSACHUSETTS AVE STE 2
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02118-2690
Country	:	US
Telephone Number	:	174-145-4056
Fax Number	:

Provider Business Practice Location Address
First Line	:	725 CONCORD AVE
Second Line	:	SUITE 2300
City	:	CAMBRIDGE
State	:	MA
Zip	:	02138-1040
Country	:	US
Telephone Number	:	617-499-9933
Fax Number	:	617-499-9935

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/19/2005
Last Update Date	:	03/17/2025

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