Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | 39854 | MA |
NPI | 1073503348 |
---|---|
Provider Name | Dr. Garner Tripp Haupert JR. |
First Address | Charlestown, MA 02129-9142 |
Second Address | Boston, MA 02114-2621 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
039854 | TUFTS HEALTH PLAN (01) | MA |
2074516 | (05) | MA |
D05413 | (02) | |
M09971 | BCBS MA (01) | MA |