Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0203X | Pediatric Critical Care Doctor | 151573 | MA |
N | 2080P0208X | Pediatric Infectious Diseases | 151573 | MA |
NPI | 1285695387 |
---|---|
Provider Name | Dr. Gregory P Priebe |
First Address | Boston, MA 02115-5724 |
Second Address | Boston, MA 02115-5724 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2006 |
Last Update Date | 13/08/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0136638 | (05) | MA |
H80499 | (02) |