Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 266866 | MA |
NPI | 1235582461 |
---|---|
Provider Name | Dr. Kathryn Isaac |
First Address | Boston, MA 02115 |
Second Address | Boston, MA 02215 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2016 |
Last Update Date | 10/10/2016 |