Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 251115 | MA |
NPI | 1013158922 |
---|---|
Provider Name | Dr. Justin Thomas Pitman |
First Address | West Roxbury, MA 02132-4428 |
Second Address | Boston, MA 02115-6110 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2009 |
Last Update Date | 16/01/2013 |