Provider Demographics
NPI:1104894518
Name:SIRULNIK, LEONARDO ANDRES (MD PHD)
Entity type:Individual
Prefix:DR
First Name:LEONARDO
Middle Name:ANDRES
Last Name:SIRULNIK
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 SAINT PAUL ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-6502
Mailing Address - Country:US
Mailing Address - Phone:617-879-1574
Mailing Address - Fax:
Practice Address - Street 1:44 BINNEY ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-6084
Practice Address - Country:US
Practice Address - Phone:617-632-5202
Practice Address - Fax:617-582-7890
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA219615207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
219615OtherTUFTS
AA2027OtherHPHC
2025906OtherMASSHEALTH
80313OtherFALLON COMMUNITY HEALTH P
3600312OtherUNITED HEALTH CARE
3364563OtherAETNA US HEALTHCARE
4107454OtherCIGNA
80313OtherFALLON COMMUNITY HEALTH P
A36261Medicare ID - Type Unspecified