Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0401X | Internist - Addiction Medicine | 131790 | MA |
NPI | 1902857063 |
---|---|
Provider Name | Debra M Foti-Flynn |
First Address | Waltham, MA 02453-2741 |
Second Address | Waltham, MA 02453-2741 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2006 |
Last Update Date | 24/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0708151 | (05) | MA |
Q72628 | (02) |