Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 73532 | MA |
NPI | 1194791863 |
---|---|
Provider Name | Ann Nicoloff Becker |
First Address | Westwood, MA 02090-2764 |
Second Address | Wellesley, MA 02481-6219 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2006 |
Last Update Date | 06/09/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3147185 | (05) | MA |
F29184 | (02) | MA |