Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 9873 | MA |
NPI | 1275708455 |
---|---|
Provider Name | Dr. Devaki Sundararajan |
First Address | Boston, MA 02118-2308 |
Second Address | Boston, MA 02118-2308 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2008 |
Last Update Date | 28/04/2008 |