Provider Demographics
NPI:1316912033
Name:NILES, JOHN L (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:L
Last Name:NILES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:101 MERRIMAC ST
Mailing Address - Street 2:1ST FLOOR, SUITE 7
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-4724
Mailing Address - Country:US
Mailing Address - Phone:617-726-4132
Mailing Address - Fax:617-726-4213
Practice Address - Street 1:101 MERRIMAC ST
Practice Address - Street 2:1ST FLOOR
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-4724
Practice Address - Country:US
Practice Address - Phone:617-726-4132
Practice Address - Fax:617-726-4213
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA54243207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ07173OtherBCBS MA
MA724621OtherTUFTS HEALTH PLAN
MA110045431/AMedicaid
MAJ07173OtherBCBS MA
B74922Medicare UPIN