Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 219223 | MA |
N | 111NI0900X | Internist | 219223 | MA |
Y | 207RG0300X | Geriatric Medicine | 219223 | MA |
NPI | 1104010958 |
---|---|
Provider Name | Dr. Jatin K Dave |
First Address | Boston, MA 02111-1552 |
Second Address | Boston, MA 02111-1552 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/09/2007 |
Last Update Date | 28/02/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I06514 | (02) |