Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 61556 | MN |
Y | 2080P0204X | Pediatric Emergency Doctor | 274166 | MA |
NPI | 1194145946 |
---|---|
Provider Name | David Mills |
First Address | Boston, MA 02115-5724 |
Second Address | Boston, MA 02115 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2014 |
Last Update Date | 13/07/2018 |