Individual
DR. JOHNATHAN MACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
55 FRUIT STREET, MASSACHUSETTS GENERAL HOSPITAL, BLOOD BANK, GRJ-238, BOSTON, MA 02114
(617) 726-3785
Mailing address
55 FRUIT STREET, MASSACHUSETTS GENERAL HOSPITAL, BLOOD BANK, GRJ-238, BOSTON, MA 02114-2621
(617) 726-3785
Taxonomy
Speciality
Code
Description
License number
State
207RH0000X
Hematology (Internal Medicine) Physician
267360
MA
207ZB0001X
Blood Banking & Transfusion Medicine Physician
Primary
267360
MA
Other
Enumeration date
05/27/2015
Last updated
09/08/2016
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