Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 77978 | MA |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 77978 | MA |
NPI | 1245214493 |
---|---|
Provider Name | Dr. Brian D Busconi |
First Address | Boston, MA 02241-0001 |
Second Address | Worcester, MA 01605-2138 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2005 |
Last Update Date | 27/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110055247A | (05) | MA |
G00935 | (02) | MA |