Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 71668 | MA |
N | 208600000X | Surgeon | 71668 | MA |
Y | 2086S0122X | Plastic and Reconstructive Surgery | 71668 | MA |
NPI | 1295792638 |
---|---|
Provider Name | Dr. Christian Sampson |
First Address | Brookline, MA 02445-6002 |
Second Address | Boston, MA 02115-6110 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2006 |
Last Update Date | 10/07/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3124894 | (05) | MA |