Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0402X | Child Neurologist | 249527 | MA |
NPI | 1295901858 |
---|---|
Provider Name | Dr. Karen Mary Stannard |
First Address | Boston, MA 02115-5724 |
Second Address | Boston, MA 02115 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2008 |
Last Update Date | 27/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110090522A | (05) | MA |
S400120301 | MEDCIARE (01) | MA |