Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 21755 | MA |
NPI | 1043371735 |
---|---|
Provider Name | Dr. Julie Pastagia |
First Address | Boston, MA 02118-2131 |
Second Address | Boston, MA 02118-2131 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2006 |
Last Update Date | 07/01/2008 |