Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 202771 | MA |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 202771 | MA |
NPI | 1033274832 |
---|---|
Provider Name | Brian J Jolley |
First Address | Burlington, MA 01805-0001 |
Second Address | Burlington, MA 01805-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2006 |
Last Update Date | 13/06/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110062114A | (05) | MA |
G00772 | (02) | MA |