Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0120X | Pediatric Surgery | 260324 | MA |
NPI | 1629360680 |
---|---|
Provider Name | Cornelia Little Griggs |
First Address | Boston, MA 02114 |
Second Address | Boston, MA 02114-2621 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2011 |
Last Update Date | 25/09/2020 |