Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 271410 | MA |
N | 207Q00000X | Family Doctor | 282318 | MA |
Y | 207QS0010X | Family Doctor - Sports Medicine | 282318 | MA |
NPI | 1194266395 |
---|---|
Provider Name | Christian M Rose |
First Address | Boston, MA 02119-3791 |
Second Address | Boston, MA 02119 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2017 |
Last Update Date | 10/10/2021 |