Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 250599 | MA |
NPI | 1124374483 |
---|---|
Provider Name | Dr. Elisabeth Beran |
First Address | Boston, MA 02115-5724 |
Second Address | Boston, MA 02115-5724 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2012 |
Last Update Date | 24/07/2012 |