Provider Demographics
NPI:1730566548
Name:LIM, JONATHAN ANDREW (MD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:ANDREW
Last Name:LIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 BURBANK ST
Mailing Address - Street 2:APT 21
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-3629
Mailing Address - Country:US
Mailing Address - Phone:636-399-7157
Mailing Address - Fax:
Practice Address - Street 1:65 BURBANK ST
Practice Address - Street 2:APT 21
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-3629
Practice Address - Country:US
Practice Address - Phone:636-399-7157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-30
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10052913207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine