Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 215952 | MA |
Y | 2080P0214X | Pediatric Pulmonologist | 215952 | MA |
NPI | 1518957752 |
---|---|
Provider Name | Dr. Christina Vestergaard Scirica |
First Address | Charlestown, MA 02129-9142 |
Second Address | Boston, MA 02114-3130 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2005 |
Last Update Date | 15/05/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2001853 | (05) | MA |
215952 | TUFTS HEALTH PLAN (01) | MA |
H78370 | (02) | |
J25803 | BCBS MA (01) | MA |