Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TH0100X | Health Service | 2982 | MA |
NPI | 1043301302 |
---|---|
Provider Name | Dr. Eileen Schwartz |
First Address | Jamaica Plain, MA 02130-3043 |
Second Address | Jamaica Plain, MA 02130-3043 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2006 |
Last Update Date | 03/12/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
W03203 | BLUE CROSS BLUE SHIELD (01) | MA |