Provider Demographics
NPI:1962527580
Name:BANKOVA, LORA G (MD)
Entity type:Individual
Prefix:
First Name:LORA
Middle Name:G
Last Name:BANKOVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 JIMMY FUND WAY
Mailing Address - Street 2:SMITH BUILDING, ROOM 638
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-6007
Mailing Address - Country:US
Mailing Address - Phone:617-525-1290
Mailing Address - Fax:
Practice Address - Street 1:850 BOYLSTON ST
Practice Address - Street 2:ALLERGY AND IMMUNOLOGY PRACTICE, SUITE 540
Practice Address - City:CHESTNUT HILL
Practice Address - State:MA
Practice Address - Zip Code:02467-2477
Practice Address - Country:US
Practice Address - Phone:617-732-9850
Practice Address - Fax:617-731-2748
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA244884390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program