Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 52777 | MA |
NPI | 1043200223 |
---|---|
Provider Name | Dr. Joseph C Kvedar |
First Address | Charlestown, MA 02129-9142 |
Second Address | Boston, MA 02114-2517 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6179665 | (05) | MA |
711334 | TUFTS HEALTH PLAN (01) | MA |
A57007 | (02) | |
J03392 | BCBS MA (01) | MA |