Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207SG0201X | Clinical Genetics (M.D.) | 208008 | MA |
N | 208000000X | Pediatrician | 208008 | MA |
NPI | 1366409526 |
---|---|
Provider Name | Dr. Deyanina Corzo |
First Address | Cambridge, MA 02142-1246 |
Second Address | Boston, MA 02115-5724 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
125091 | (05) | MA |