Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YP0228X | Pediatric Otolaryngology | 282066 | MA |
NPI | 1043840432 |
---|---|
Provider Name | Dr. Fergal Kavanagh |
First Address | Boston, MA 02116-1600 |
Second Address | Boston, MA 02115-5724 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2020 |
Last Update Date | 24/01/2020 |