Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | 160283 | MA |
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | MD13753 | RI |
NPI | 1083663298 |
---|---|
Provider Name | Bruce Andrew Koplan |
First Address | Brookline, MA 02445-6002 |
Second Address | Boston, MA 02115 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2006 |
Last Update Date | 22/12/2021 |