Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 239784 | MA |
N | 207N00000X | Dermatologist | MA080103 | NJ |
NPI | 1013174903 |
---|---|
Provider Name | Dr. Clara D Cokonis |
First Address | Wellesley, MA 02481-5491 |
Second Address | Wellesley, MA 02481-5491 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2008 |
Last Update Date | 04/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110083810A | (05) | MA |