Provider Demographics
NPI:1942202320
Name:LAM, PRUDENCE (MD)
Entity Type:Individual
Prefix:DR
First Name:PRUDENCE
Middle Name:
Last Name:LAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 MOUNT AUBURN ST
Mailing Address - Street 2:WYMAN 3
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-5502
Mailing Address - Country:US
Mailing Address - Phone:617-497-9646
Mailing Address - Fax:617-499-5464
Practice Address - Street 1:330 MOUNT AUBURN ST
Practice Address - Street 2:WYMAN 3
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-5502
Practice Address - Country:US
Practice Address - Phone:617-497-9646
Practice Address - Fax:617-499-5464
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA217283207R00000X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2029987Medicaid
MA2029987Medicaid
MAMX7461Medicare PIN