Individual
DR. JORDAN W SMOLLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
15 PARKMAN ST, PSYCHIATRY OUTPATIENT DEPARTMENT WAC 8, BOSTON, MA 02114-3117
(617) 724-0835
Mailing address
PO BOX 9142, MASS GENERAL PHYSICIAN ORGANIZATION, CHARLESTOWN, MA 02129-9142
(617) 724-0835
(617) 726-0850
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
78848
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3175065
—
MA
01
—
759971
TUFTS HEALTH PLAN
MA
01
—
J18506
BCBS MA
MA
Enumeration date
03/14/2006
Last updated
01/08/2013
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