Provider Demographics
NPI:1942731765
Name:LAKS, JORDANA (MD, MPH)
Entity Type:Individual
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First Name:JORDANA
Middle Name:
Last Name:LAKS
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Gender:F
Credentials:MD, MPH
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Mailing Address - Street 1:801 ALBANY STREET
Mailing Address - Street 2:FL GROUND PROVIDER ENROLLMENT
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02119
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:725 ALBANY ST
Practice Address - Street 2:SHAPIRO 5 C
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2526
Practice Address - Country:US
Practice Address - Phone:617-414-5951
Practice Address - Fax:617-414-9201
Is Sole Proprietor?:No
Enumeration Date:2017-03-23
Last Update Date:2022-02-03
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Provider Licenses
StateLicense IDTaxonomies
MA2827702083A0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction Medicine