Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 250780 | MA |
NPI | 1154678183 |
---|---|
Provider Name | Dr. Arul Dominic Furtado |
First Address | Brookline, MA 02445-7163 |
Second Address | Boston, MA 02115-6110 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2012 |
Last Update Date | 09/08/2012 |