Individual
IBIAYI DAGOGO-JACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
55 FRUIT ST, BOSTON, MA 02114-2621
(617) 724-1134
Mailing address
55 FRUIT ST, BOSTON, MA 02114-2621
(617) 724-1134
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
247954
MA
207RH0003X
Hematology & Oncology Physician
262564
MA
207RX0202X
Medical Oncology Physician
Primary
262564
MA
Other
Enumeration date
06/18/2011
Last updated
01/15/2026
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