Provider Demographics
NPI:1447200969
Name:COBLYN, JONATHAN SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:SCOTT
Last Name:COBLYN
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 1:75 FRANCIS STREET PBB B3
Mailing Address - Street 2:BRIGHAM AND WOMEN'S HOSPITAL DEPT OF RHEUMATOLOGY IMMUN
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115
Mailing Address - Country:US
Mailing Address - Phone:617-732-5347
Mailing Address - Fax:
Practice Address - Street 1:75 FRANCIS STREET PBB B3
Practice Address - Street 2:BRIGHAM AND WOMEN'S HOSPITAL DEPT OF RHEUMATOLOGY IMMUN
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115
Practice Address - Country:US
Practice Address - Phone:617-732-5347
Practice Address - Fax:617-582-6151
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA41304207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2069032Medicaid