Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0202X | Pediatric Cardiologist | 60399 | MA |
NPI | 1063403384 |
---|---|
Provider Name | Dr. Gerald Ross Marx |
First Address | Brookline, MA 02446-9135 |
Second Address | Boston, MA 02115-5724 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2005 |
Last Update Date | 28/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3038831 | (05) | MA |
D44219 | (02) | |
GM27010 | (05) | RI |