Provider Demographics
NPI:1013182500
Name:SKOTKO, BRIAN GARY (MD, MPP)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:GARY
Last Name:SKOTKO
Suffix:
Gender:M
Credentials:MD, MPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 CAMBRIDGE ST RM 2222
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2790
Mailing Address - Country:US
Mailing Address - Phone:617-643-3196
Mailing Address - Fax:
Practice Address - Street 1:185 CAMBRIDGE ST RM 2222
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2790
Practice Address - Country:US
Practice Address - Phone:617-643-3196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-25
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA235304207SG0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)