Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | L-228714 | MA |
N | 208600000X | Surgeon | L-228714 | MA |
Y | 2086X0206X | Surgical Oncologist | P7090 | TX |
NPI | 1366578098 |
---|---|
Provider Name | Claudius Conrad |
First Address | Brighton, MA 02135-3514 |
Second Address | Brighton, MA 02135-3514 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2007 |
Last Update Date | 29/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
324248901 | (05) | TX |