Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 9699 | MA |
NPI | 1083604763 |
---|---|
Provider Name | Dr. Barry Joseph Agranat |
First Address | Charlestown, MA 02129-9142 |
Second Address | Watertown, MA 02472-3931 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T56445 | (02) |