Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207U00000X | Nuclear Medicine Specialist | 35398 | MA |
NPI | 1669453486 |
---|---|
Provider Name | Dr. Kenneth Robert Davis |
First Address | Charlestown, MA 02129-9142 |
Second Address | Boston, MA 02114-2696 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
035398 | TUFTS HEALTH PLAN (01) | MA |
2084864 | (05) | MA |
B75896 | (02) | |
M08609 | BCBS MA (01) | MA |