Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 254034 | MA |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 254034 | MA |
NPI | 1013179787 |
---|---|
Provider Name | Anu Rupa Mehra |
First Address | East Boston, MA 02128-1920 |
Second Address | East Boston, MA 02128-1920 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2008 |
Last Update Date | 31/07/2013 |