1538436209 NPI number — SANTIAGO ANDRES LOZANO CALDERON MD, PHD

Table of content: SANTIAGO ANDRES LOZANO CALDERON MD, PHD (NPI 1538436209)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538436209 NPI number — SANTIAGO ANDRES LOZANO CALDERON MD, PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOZANO CALDERON
Provider First Name:
SANTIAGO
Provider Middle Name:
ANDRES
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD, PHD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538436209
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/05/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
55 FRUIT ST
Provider Second Line Business Mailing Address:
SUITE 3700-3B YAWKEY OUTPATIENT CARE CENTER, MGH
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02114-2621
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-726-0604
Provider Business Mailing Address Fax Number:
617-726-6823

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
55 FRUIT ST
Provider Second Line Business Practice Location Address:
SUITE 3700-3B YAWKEY OUTPATIENT CARE CENTER, MGH
Provider Business Practice Location Address City Name:
BOSTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02114-2621
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-726-6823
Provider Business Practice Location Address Fax Number:
617-726-6823
Provider Enumeration Date:
11/24/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  250247 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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