Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 13653 | MA |
Y | 213EG0000X | General Practice | 13653 | MA |
NPI | 1003823303 |
---|---|
Provider Name | Dr. Frank J Balboa |
First Address | Newton, MA 02458-1433 |
Second Address | Newton, MA 02458-1433 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2006 |
Last Update Date | 08/07/2007 |