Provider Demographics
NPI:1609239144
Name:NUDEL, JACOB D (MD)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:D
Last Name:NUDEL
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Gender:
Credentials:MD
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Mailing Address - Street 1:960 MASSACHUSETTS AVENUE
Mailing Address - Street 2:FL 2
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2690
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:725 ALBANY STREET, SUITE 3B
Practice Address - Street 2:SHAPIRO BLDG.
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118
Practice Address - Country:US
Practice Address - Phone:617-414-8052
Practice Address - Fax:617-638-8053
Is Sole Proprietor?:No
Enumeration Date:2016-04-01
Last Update Date:2025-03-11
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Provider Licenses
StateLicense IDTaxonomies
MA277165208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110117210AMedicaid
NH3143020Medicaid