Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | MA54221 | MA |
N | 111NI0900X | Internist | MA54221 | MA |
Y | 207RA0401X | Internist - Addiction Medicine | MA54221 | MA |
N | 207RC0200X | Critical Care Medicine | MA54221 | MA |
NPI | 1518024801 |
---|---|
Provider Name | Carol V Garner |
First Address | Jamaica Plain, MA 02130-3735 |
Second Address | Jamaica Plain, MA 02130-3735 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2007 |
Last Update Date | 30/04/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A50495 | (02) | MA |