Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | 79135 | MA |
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 79135 | MA |
NPI | 1750361150 |
---|---|
Provider Name | Dr. Debra A Twehous |
First Address | Boston, MA 02241-5348 |
Second Address | Worcester, MA 01602-4339 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2006 |
Last Update Date | 29/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110054348A | (05) | MA |
3123855 | (05) | MA |
F12058 | (02) |