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Provider Information for 1225093552

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

DR. JONATHAN D PICKER MD,PHD

Gender: MALE

Individual NPI: 1225093552

Calendar   Last Updated:  2007-07-08
  Certification Date: 

Details

Name Value
NPI 1225093552
Enumeration Date 2006-04-19
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 64 GLEN RD #9
BROOKLINE, MA 02445-7757
United States

Phone: 617-783-1948 | Fax:
View Map External Link
Primary Practice Address 300 LONGWOOD AVE
BOSTON, MA 02115-5724
United States

Phone: 617-355-6394 | Fax: 617-730-0466
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
MEDICAID MA 0195502
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 207SG0201X - Medical Genetics Clinical Genetics (M.D.) MA 213029