Individual
MRS. IVA JANDOVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2100 DORCHESTER AVE, STEWARD CARNEY HOSPITAL, DORCHESTER, MA 02124
(617) 506-4504
Mailing address
61 LINDEN ST, BROOKLINE, MA 02445-7841
(617) 710-0379
Taxonomy
Speciality
Code
Description
License number
State
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
161099
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0116513
—
MA
05
—
A31842
—
MA
Enumeration date
05/03/2006
Last updated
06/02/2021
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