Provider Demographics
NPI:1669883245
Name:SACK, JORDAN S (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:S
Last Name:SACK
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:45 FRANCIS ST
Mailing Address - Street 2:ASB-II, GI CLINIC
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-6110
Mailing Address - Country:US
Mailing Address - Phone:617-732-6389
Mailing Address - Fax:617-566-0338
Practice Address - Street 1:45 FRANCIS ST
Practice Address - Street 2:ASB-II, GI CLINIC
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-6110
Practice Address - Country:US
Practice Address - Phone:617-732-6389
Practice Address - Fax:617-566-0338
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-16
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA287611207RI0008X, 207RG0100X, 207RT0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatology
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207RT0003XAllopathic & Osteopathic PhysiciansInternal MedicineTransplant Hepatology