Provider Demographics
NPI:1689687956
Name:LO, CLIFFORD (MD)
Entity Type:Individual
Prefix:DR
First Name:CLIFFORD
Middle Name:
Last Name:LO
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 1:15 OAK KNLS
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02476-6407
Mailing Address - Country:US
Mailing Address - Phone:781-641-3735
Mailing Address - Fax:
Practice Address - Street 1:300 LONGWOOD AVE
Practice Address - Street 2:BOSTON CHILDRENS HOSPITAL
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5724
Practice Address - Country:US
Practice Address - Phone:617-355-7612
Practice Address - Fax:617-730-0496
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA48973208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3010730Medicaid
A58566Medicare UPIN
MA3010730Medicaid