Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TH0100X | Health Service | 9963 | MA |
NPI | 1497088215 |
---|---|
Provider Name | Dr. Giancarlo Fusco |
First Address | Stoneham, MA 02180-2736 |
Second Address | Newton, MA 02464-1457 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/09/2009 |
Last Update Date | 21/08/2014 |