Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YP0228X | Pediatric Otolaryngology | 273578 | MA |
NPI | 1225546419 |
---|---|
Provider Name | Dr. Gerard Thong |
First Address | Boston, MA 02115-1602 |
Second Address | Boston, MA 02115 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2018 |
Last Update Date | 22/01/2018 |