Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 154551 | MA |
N | 207VG0400X | Gynecologist | 154551 | MA |
NPI | 1013968551 |
---|---|
Provider Name | Alisa B Goldberg |
First Address | Boston, MA 02215-1001 |
Second Address | Boston, MA 02115 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2006 |
Last Update Date | 27/06/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2035651 | (05) | MA |