Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 47855 | MA |
Y | 208600000X | Surgeon | 47855 | MA |
N | 2086S0102X | Surgical Critical Care | 47855 | MA |
NPI | 1275603573 |
---|---|
Provider Name | Dr. Jonathan F Critchlow |
First Address | Boston, MA 02215-5501 |
Second Address | Boston, MA 02215-5501 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2006 |
Last Update Date | 15/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B96417 | (02) | MA |