Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 213542 | MA |
NPI | 1013994599 |
---|---|
Provider Name | Dr. Dianne E Sacco |
First Address | Charlestown, MA 02129-9142 |
Second Address | Boston, MA 02114-2621 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/12/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2005638 | (05) | MA |
792333 | TUFTS HEALTH PLAN (01) | MA |
H84049 | (02) | |
J25979 | BCBS MA (01) | MA |