Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | 216291 | MA |
NPI | 1073504205 |
---|---|
Provider Name | Dr. Giacomo P Basadonna |
First Address | Shrewsbury, MA 01545-0062 |
Second Address | Worcester, MA 01655-0002 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/11/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0185639 | (05) | MA |
F45855 | (02) | MA |