Basic Information
| Provider Information | |||||||||
| NPI: | 1710993084 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SAMET | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | H. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D., M.A., M.P.H. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 801 ALBANY ST FL GROUND | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021192560 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | |||||||||
| FaxNumber: | 6174149201 | ||||||||
| Practice Location | |||||||||
| Address1: | 801 MASSACHUSETTS AVE | ||||||||
| Address2: | CROSSTOWN 6A | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021182605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6174145951 | ||||||||
| FaxNumber: | 6174149201 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2006 | ||||||||
| LastUpdateDate: | 04/08/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RA0401X | 53857 | MA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Addiction Medicine | 207R00000X | 53857 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 110065625A | 05 | MA | MEDICAID |