Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 2709 | MA |
NPI | 1669544011 |
---|---|
Provider Name | Dr. Jonathan David Yalowchuk |
First Address | Weymouth, MA 02188-3325 |
Second Address | Weymouth, MA 02188-3325 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Y36917 | BCBS (01) | MA |