Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 50854 | MA |
NPI | 1003959578 |
---|---|
Provider Name | Claire Prouty Mansur |
First Address | Boston, MA 02118-4001 |
Second Address | Boston, MA 02118-2526 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2007 |
Last Update Date | 20/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3078167 | (05) | MA |