Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | ET90-064 | MA |
N | 111NI0900X | Internist | ET90-064 | MA |
N | 207RH0000X | Hematologist | ET90-064 | MA |
Y | 207RX0202X | Medical Oncology | ET90-064 | MA |
NPI | 1417365370 |
---|---|
Provider Name | Camille Vanessa Edwards |
First Address | Boston, MA 02119 |
Second Address | Boston, MA 02118 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2014 |
Last Update Date | 29/05/2020 |