Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 59769 | MA |
NPI | 1114971454 |
---|---|
Provider Name | Diane T. Power |
First Address | Boston, MA 02241-5348 |
Second Address | Leominster, MA 01453-2238 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2006 |
Last Update Date | 18/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3007626 | (05) | MA |
B75081 | (02) |