Individual
DR. TIMOTHY LAX
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1 BROOKLINE PL, SUITE 623, BROOKLINE, MA 02445-7224
(617) 278-8100
Mailing address
1 BROOKLINE PL, SUITE 623, BROOKLINE, MA 02445-7224
(617) 278-8100
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
248449
MA
207RA0201X
Allergy & Immunology (Internal Medicine) Physician
Primary
248449
MA
2080P0207X
Pediatric Hematology & Oncology Physician
036120469
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036120469
MEDICAL LICENSE NUMBER
IL
01
—
248449
MEDICAL LICENSE
MA
Enumeration date
08/01/2008
Last updated
07/07/2015
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