Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 42003 | MA |
NPI | 1073539516 |
---|---|
Provider Name | Dr. John A. Rousou |
First Address | Springfield, MA 01199-1001 |
Second Address | Springfield, MA 01107-1619 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2006 |
Last Update Date | 14/11/2016 |