Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 249455 | MA |
Y | 2080P0203X | Pediatric Critical Care Doctor | 249455 | MA |
NPI | 1225248818 |
---|---|
Provider Name | Dr. David Scott Tiber |
First Address | Boston, MA 02241-5348 |
Second Address | Worcester, MA 01655-0002 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2007 |
Last Update Date | 10/11/2020 |