Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 208533 | MA |
Y | 111NI0900X | Internist | 208533 | MA |
N | 207RG0300X | Geriatric Medicine | 208533 | ME |
NPI | 1124111000 |
---|---|
Provider Name | Dr. Abisola Bernice Mesioye |
First Address | Baltomore, MD 21218 |
Second Address | Bedford, MA 01730-1114 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2006 |
Last Update Date | 10/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H51388 | (02) |