Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | 215122 | MA |
NPI | 1609884519 |
---|---|
Provider Name | Dr. Ian James Thornley |
First Address | Auburndale, MA 02466 |
Second Address | Salem, MA 01970 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0175587 | (05) | MA |
H67427 | (02) |