Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 207Y00000X | MA |
NPI | 1063031425 |
---|---|
Provider Name | Dr. Isaac Wasserman |
First Address | Cambridge, MA 02139-4337 |
Second Address | Boston, MA 02114-3002 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2020 |
Last Update Date | 15/04/2020 |