Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2084N0400X | Neurologist | 226596 | MA |
Y | 2084N0402X | Child Neurologist | 226596 | MA |
NPI | 1053380618 |
---|---|
Provider Name | Christy D Stine |
First Address | Boston, MA 02241-5348 |
Second Address | Worcester, MA 01655-0002 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2006 |
Last Update Date | 22/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110041922A | (05) | MA |