Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208800000X | Urologist | 246602 | MA |
Y | 208800000X | Urologist | MD15411 | RI |
NPI | 1013177518 |
---|---|
Provider Name | Boris Gershman |
First Address | Providence, RI 02904-1869 |
Second Address | Providence, RI 02904-1869 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2008 |
Last Update Date | 24/06/2016 |