Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 81234 | MA |
Y | 2080P0204X | Pediatric Emergency Doctor | 81234 | MA |
NPI | 1316905474 |
---|---|
Provider Name | Dr. June G Hanly |
First Address | Boston, MA 02115-5737 |
Second Address | Boston, MA 02115-5724 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2006 |
Last Update Date | 16/08/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3139610 | (05) | MA |
F60862 | (02) |