Provider Demographics
NPI:1043216765
Name:ACKIL, JOSEPH ALBERT (DO)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:ALBERT
Last Name:ACKIL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CORINTH ST
Mailing Address - Street 2:
Mailing Address - City:ROSLINDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02131-3014
Mailing Address - Country:US
Mailing Address - Phone:617-327-3450
Mailing Address - Fax:617-327-0573
Practice Address - Street 1:1 CORINTH ST
Practice Address - Street 2:
Practice Address - City:ROSLINDALE
Practice Address - State:MA
Practice Address - Zip Code:02131-3014
Practice Address - Country:US
Practice Address - Phone:617-327-3450
Practice Address - Fax:617-327-0573
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-27
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA30313207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2024608Medicaid
MAA65833Medicare UPIN
MA2024608Medicaid