Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VE0102X | Reproductive Endocrinologist | 73931 | MA |
N | 207VG0400X | Gynecologist | 73931 | MA |
NPI | 1013022078 |
---|---|
Provider Name | Charles-Chidi W Obasiolu |
First Address | Boston, MA 02109-4806 |
Second Address | Boston, MA 02215 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2006 |
Last Update Date | 07/07/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3180468 | (05) | MA |