Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 241114 | MA |
Y | 2080P0202X | Pediatric Cardiologist | 277037 | NY |
NPI | 1104052778 |
---|---|
Provider Name | Dr. Jaclyn Mckinstry |
First Address | Roxbury Crossing, MA 02120-1677 |
Second Address | Boston, MA 02115-5724 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2009 |
Last Update Date | 29/05/2020 |