Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 219364 | MA |
Y | 208600000X | Surgeon | 219364 | MA |
NPI | 1023053048 |
---|---|
Provider Name | Ashley Haralson Vernon |
First Address | Brookline, MA 02445-6002 |
Second Address | Boston, MA 02115 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2006 |
Last Update Date | 09/08/2012 |