Provider Demographics
NPI:1174579718
Name:KLEMENT, GIANNOULA LAKKA (MD)
Entity type:Individual
Prefix:
First Name:GIANNOULA
Middle Name:LAKKA
Last Name:KLEMENT
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 1:45 HEMENWAY ST
Mailing Address - Street 2:UNIT 1
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115
Mailing Address - Country:US
Mailing Address - Phone:617-536-0515
Mailing Address - Fax:617-562-7142
Practice Address - Street 1:800 WASHINGTON ST
Practice Address - Street 2:FLOATING HOSPITAL FOR CHILDREN AT TUFTS MEDICAL CENTER
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-1552
Practice Address - Country:US
Practice Address - Phone:617-636-5535
Practice Address - Fax:617-636-7738
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2193132080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
2025990OtherMASSHEALTH (MA MEDICAID)
AA11828OtherHPHC (DFCI ONLY)
219313OtherTUFTS
J26938OtherBCBS OF MA, INDEMNITY, BC
4460262OtherCIGNA
80300OtherFALLON COMMUNITY HEALTH P
2025990OtherMASSHEALTH (MA MEDICAID)
AA11828OtherHPHC (DFCI ONLY)