Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | 251627 | MA |
NPI | 1053666222 |
---|---|
Provider Name | Dr. Eva Brigid Long |
First Address | Boston, MA 02118-2908 |
Second Address | Boston, MA 02118-2908 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2012 |
Last Update Date | 13/07/2012 |