Provider Demographics
NPI:1154939569
Name:ULATAN, JEFFREY
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:
Last Name:ULATAN
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:JEFFREY
Other - Middle Name:CAGALITAN
Other - Last Name:ULATAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:424 OXFORD ST
Mailing Address - Street 2:GSAS MAIL CENTER
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138
Mailing Address - Country:US
Mailing Address - Phone:317-647-4390
Mailing Address - Fax:317-647-4390
Practice Address - Street 1:25 SHATTUCK ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-6027
Practice Address - Country:US
Practice Address - Phone:646-760-5333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA31724171744R1102X, 246ZB0301X, 208D00000X
MAAAM3172417207SG0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No1744R1102XOther Service ProvidersSpecialistResearch Study
No207SG0203XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Molecular Genetics
No246ZB0301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherBiomedical Engineering
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA15361568OtherAAMC
MA24578497OtherPARTNERS
MAAAM-5560-2020OtherRESEARCHID
MA4262900OtherSSRN
GU0000-0002-3756-0568OtherORCID