Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 213500 | MA |
NPI | 1043272453 |
---|---|
Provider Name | Anand K Devaiah |
First Address | Boston, MA 02119-3791 |
Second Address | Boston, MA 02118-2905 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2006 |
Last Update Date | 06/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110006002A | (05) | MA |