Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 54348 | MA |
NPI | 1164413449 |
---|---|
Provider Name | Dr. John Charles Wain |
First Address | Charlestown, MA 02129-9142 |
Second Address | Boston, MA 02114-2696 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3036847 | (05) | MA |
712604 | TUFTS HEALTH PLAN (01) | MA |
D94105 | (02) | |
J04296 | BCBS OF MA (01) | MA |