Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 246791 | MA |
Y | 111NI0900X | Internist | 246791 | MA |
N | 207RE0101X | Endocrinologist (Diabetes Doctor) | 246791 | MA |
NPI | 1083765036 |
---|---|
Provider Name | Anca Goller |
First Address | Concord, MA 01742-2137 |
Second Address | Concord, MA 01742-2137 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2007 |
Last Update Date | 09/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110089000A | (05) | MA |