Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207ND0900X | Dermatopathologist | 208889 | MA |
NPI | 1619986114 |
---|---|
Provider Name | Dr. Karen C. Mitchell |
First Address | Marlborough, MA 01752-3200 |
Second Address | Marlborough, MA 01752-3200 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2006 |
Last Update Date | 08/01/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110062526A | (05) | MA |
G74961 | (02) | MA |