Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 243580 | MA |
Y | 2080P0208X | Pediatric Infectious Diseases | 243580 | MA |
NPI | 1073791661 |
---|---|
Provider Name | Dr. Jeffrey Daniel Dvorin |
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 | 05/02/2008 |
Last Update Date | 29/10/2010 |