Individual
LARISSA NEKHLYUDOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
133 BROOKLINE AVE, 6TH FLOOR, BOSTON, MA 02215-3904
(617) 421-5804
(617) 421-8865
Mailing address
147 MILK ST, PROVIDER ENROLLMENT - 9TH FLOOR, BOSTON, MA 02109-4806
(617) 559-8374
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
202502
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0018938
NEIGHBORHOOD HEALTH
MA
01
—
202502
TUFTS
MA
05
—
3206556
—
MA
01
—
J22143
BLUE CROSS
MA
01
—
V922
HARVARD PILGRIM
MA
Enumeration date
07/04/2006
Last updated
01/10/2014
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