Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 17008 | MA |
Y | 204E00000X | Oral & Maxillofacial Surgeon | 75473 | MA |
NPI | 1558351866 |
---|---|
Provider Name | Dr. Bonnie L Padwa |
First Address | Boston, MA 02115-5724 |
Second Address | Boston, MA 02115-5724 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2005 |
Last Update Date | 21/10/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3101207 | (05) | MA |
730778 | TUFTS HEALTH PLAN (01) | MA |
F41373 | (02) | |
J13074 | BCBS MA (01) | MA |