Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 229958 | MA |
Y | 2080A0000X | Adolescent Medicine | 229958 | MA |
NPI | 1043277924 |
---|---|
Provider Name | Dr. Kathryn Susan Brigham |
First Address | Boston, MA 02114-2696 |
Second Address | Boston, MA 02114 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2006 |
Last Update Date | 10/08/2018 |