Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | 225070 | MA |
NPI | 1083682058 |
---|---|
Provider Name | Dr. Derrick James Todd |
First Address | Brookline, MA 02445-6002 |
Second Address | Jamaica Plain, MA 02130-3446 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2006 |
Last Update Date | 08/06/2012 |