Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 57132 | MA |
Y | 2080P0204X | Pediatric Emergency Doctor | 57132 | MA |
NPI | 1003865270 |
---|---|
Provider Name | Dr. Baruch Shlomo Krauss |
First Address | Boston, MA 02115-4519 |
Second Address | Boston, MA 02115-4519 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2006 |
Last Update Date | 16/08/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3045230 | (05) | MA |
D87929 | (02) |