Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 77317 | MA |
Y | 2080P0207X | Pediatric Hematology-Oncologist | 77317 | MA |
NPI | 1003898297 |
---|---|
Provider Name | Dr. David Henry Ebb |
First Address | Charlestown, MA 02129-9142 |
Second Address | Boston, MA 02114-2696 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2005 |
Last Update Date | 18/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3111202 | (05) | MA |
730166 | TUFTS HEALTH PLAN (01) | MA |
F61704 | (02) | |
J13960 | BCBS MA (01) | MA |