Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | 33199 | DC |
NPI | 1457349987 |
---|---|
Provider Name | Cal Matsumoto |
First Address | Boston, MA 02241-8283 |
Second Address | Washington, DC 20007-2113 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2005 |
Last Update Date | 09/03/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G95708 | (02) | |
P00678665 | RAILROAD MEDICARE (01) | DC |