Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 1149 | MA |
NPI | 1184788820 |
---|---|
Provider Name | Dr. Gail Therese Hepburn |
First Address | Boston, MA 02118-3505 |
Second Address | Boston, MA 02118-3505 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1608045 | (05) | MA |