Basic Information
Provider Information | |||||||||
NPI: | 1427357888 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | O'DONNELL LURIA | ||||||||
FirstName: | ANNE | ||||||||
MiddleName: | ELIZABETH | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D., PH.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | O'DONNELL | ||||||||
OtherFirstName: | ANNE | ||||||||
OtherMiddleName: | ELIZABETH | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | M.D., PH.D. | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 300 LONGWOOD AVE | ||||||||
Address2: | HUNNEWELL 5 | ||||||||
City: | BOSTON | ||||||||
State: | MA | ||||||||
PostalCode: | 021155724 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6173556369 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 300 LONGWOOD AVE | ||||||||
Address2: | HUNNEWELL 5 | ||||||||
City: | BOSTON | ||||||||
State: | MA | ||||||||
PostalCode: | 021155724 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6173556369 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/23/2011 | ||||||||
LastUpdateDate: | 05/24/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 262391 | MA | N |   | Allopathic & Osteopathic Physicians | Pediatrics |   | 207SG0201X | 262391 | MA | Y |   | Allopathic & Osteopathic Physicians | Medical Genetics | Clinical Genetics (M.D.) |
No ID Information.