Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 231213 | MA |
Y | 2080P0207X | Pediatric Hematology-Oncologist | 243889 | MA |
NPI | 1265463046 |
---|---|
Provider Name | Dr. Brian D. Crompton |
First Address | Boston, MA 02115-6013 |
Second Address | Boston, MA 02115-6013 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2006 |
Last Update Date | 20/08/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A902460 | (05) | CA |
I55512 | (02) |