Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 245418 | MA |
Y | 111NI0900X | Internist | 245418 | MA |
NPI | 1003074667 |
---|---|
Provider Name | Dr. Felicia Elizabeth Patch |
First Address | Boston, MA 02118 |
Second Address | Boston, MA 02118-2605 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2008 |
Last Update Date | 16/04/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110086449A | (05) | MA |