Individual
SAMUEL JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1 BOSTON MEDICAL CTR PL, BOSTON, MA 02118-2908
(617) 414-5245
Mailing address
960 MASSACHUSETTS AVE STE 2, BOSTON, MA 02118-2690
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
1023020
MA
2084P0800X
Psychiatry Physician
MD61035793
WA
Other
Enumeration date
03/30/2016
Last updated
10/03/2025
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