Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RH0000X | Hematologist | 279255 | MA |
Y | 207RX0202X | Medical Oncology | 279255 | MA |
NPI | 1184827107 |
---|---|
Provider Name | Dr. Clifton Craig Mo |
First Address | Boston, MA 02215-5450 |
Second Address | Boston, MA 02215 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2007 |
Last Update Date | 02/07/2019 |