Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 257157 | MA |
Y | 111NI0900X | Internist | 257157 | MA |
NPI | 1003090499 |
---|---|
Provider Name | Dr. Adepeju Gbadebo Champion |
First Address | Boston, MA 02241-5348 |
Second Address | Worcester, MA 01655-0002 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2007 |
Last Update Date | 27/10/2020 |