Provider Demographics
NPI:1073817524
Name:LIM, ELGENE (MD)
Entity Type:Individual
Prefix:DR
First Name:ELGENE
Middle Name:
Last Name:LIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 BINNEY ST
Mailing Address - Street 2:YAWKEY 1242
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02446
Mailing Address - Country:US
Mailing Address - Phone:617-632-3000
Mailing Address - Fax:617-632-1930
Practice Address - Street 1:44 BINNEY ST
Practice Address - Street 2:YAWKEY 1242
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02446
Practice Address - Country:US
Practice Address - Phone:617-632-3000
Practice Address - Fax:617-632-1930
Is Sole Proprietor?:No
Enumeration Date:2010-12-27
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA246077207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA246077OtherMASSACHUSETTS MEDICAL BOARD LICENSE NUMBER