Provider Demographics
NPI:1346268885
Name:SOUL, JANET S (MD)
Entity Type:Individual
Prefix:DR
First Name:JANET
Middle Name:S
Last Name:SOUL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 LONGWOOD AVE
Mailing Address - Street 2:FEGAN 11
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-5724
Mailing Address - Country:US
Mailing Address - Phone:617-355-6388
Mailing Address - Fax:617-730-0284
Practice Address - Street 1:300 LONGWOOD AVE
Practice Address - Street 2:FEGAN 11
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5724
Practice Address - Country:US
Practice Address - Phone:617-355-6388
Practice Address - Fax:617-730-0284
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1536702084N0400X, 208000000X, 2084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3182177Medicaid
MA3182177Medicaid
MAA28423Medicare ID - Type Unspecified