Provider Demographics
NPI:1528226271
Name:LO, MINDY S (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:MINDY
Middle Name:S
Last Name:LO
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Gender:F
Credentials:MD, PHD
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Mailing Address - Street 1:300 LONGWOOD AVE
Mailing Address - Street 2:CHILDREN'S HOSPITAL BOSTON
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115
Mailing Address - Country:US
Mailing Address - Phone:617-355-6363
Mailing Address - Fax:617-730-0249
Practice Address - Street 1:300 LONGWOOD AVE
Practice Address - Street 2:CHILDREN'S HOSPITAL BOSTON
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115
Practice Address - Country:US
Practice Address - Phone:617-355-6363
Practice Address - Fax:617-730-0249
Is Sole Proprietor?:No
Enumeration Date:2008-05-29
Last Update Date:2015-08-26
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Provider Licenses
StateLicense IDTaxonomies
MA239230208000000X, 2080P0216X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0216XAllopathic & Osteopathic PhysiciansPediatricsPediatric Rheumatology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics