Provider Demographics
NPI:1154383610
Name:SOBELL, JEFFREY MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:MICHAEL
Last Name:SOBELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1244 BOYLSTON ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467-2116
Mailing Address - Country:US
Mailing Address - Phone:617-731-1600
Mailing Address - Fax:617-731-1601
Practice Address - Street 1:1244 BOYLSTON ST
Practice Address - Street 2:SUITE 302
Practice Address - City:CHESTNUT HILL
Practice Address - State:MA
Practice Address - Zip Code:02467-2116
Practice Address - Country:US
Practice Address - Phone:617-731-1600
Practice Address - Fax:617-731-1601
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA153643207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
2972305OtherAETNA
0014048OtherNHP
772002OtherTUFTS
MAJ17603OtherBLUE SHIELD
5544925003OtherCIGNA
35661OtherFALLON
300215OtherUNITED
400891OtherHPHC
300215OtherUNITED
A22357Medicare ID - Type Unspecified