Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 246128 | NY |
Y | 2080P0207X | Pediatric Hematology-Oncologist | 238609 | MA |
NPI | 1215183256 |
---|---|
Provider Name | Dr. Brenton Garrett Mar |
First Address | Boston, MA 02118-3180 |
Second Address | Boston, MA 02115-5724 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2008 |
Last Update Date | 24/06/2009 |